Evaluation of the microcirculation of hepatocellular carcinomas using contrast-enhanced ultrasound with intraarterial and intravenous contrast application during transarterial chemoembolization with drug-eluting beads (DEB-TACE): preliminary data

• Published in: Clinical hemorheology and microcirculation Vol. 49; no. 1-4; pp. 55 - 66
• Main Authors: Uller, W, Wiggermann, P, Gössmann, H, Klebl, F, Salzberger, B, Stroszczynski, C, Jung, E M
• Format: Journal Article
• Language: English
• Published: Netherlands 2011
• Subjects: Aged; Antibiotics, Antineoplastic - administration & dosage; Antibiotics, Antineoplastic - pharmacokinetics; Antibiotics, Antineoplastic - therapeutic use; Carcinoma, Hepatocellular - blood supply; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic; Contrast Media - administration & dosage; Doxorubicin - administration & dosage; Doxorubicin - pharmacokinetics; Doxorubicin - therapeutic use; Female; Humans; Infusions, Intra-Arterial; Infusions, Intravenous; Liver Circulation; Liver Neoplasms - blood supply; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - therapy; Male; Microbubbles; Microcirculation; Microspheres; Middle Aged; Multidetector Computed Tomography; Phospholipids; Radiography, Interventional - methods; Sulfur Hexafluoride; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Interventional - methods
• ISSN: 1386-0291; 1875-8622
• DOI: 10.3233/CH-2011-1457

The objective was the evaluation of microcirculation in hepatocellular carcinomas (HCC) in vivo by dynamic contrast-enhanced ultrasound (CEUS) after intravenous (i.v.) and intraarterial (i.a.) application of contrast agent during transarterial chemoembolization (TACE) using drug-eluting beads (DEB). Eleven patients with HCC underwent CEUS directly before and immediately after DEB-TACE. The sonographic contrast agent was injected through the microcatheter intraarterially and intravenously. The grade of hypervascularization was evaluated before Bead application. The percentage of devascularization after Bead application was calculated and quantitative devascularization was carried out using time intensity curves (TIC). These results were compared to postinterventional angiography after Bead application and postprocedural computed tomography. The hypervascularization of HCC was marginal improved after i.a. contrast application compared to i.v. application (p = 0.163). The reduction of vascularization after Bead application correlated significant between i.a. and i.v. contrast application (p = 0.007) and decreased significant using TIC analysis (p = 0.003). Postinterventional angiography related with CEUS after i.a. sonographic contrast agent application. Extrahepatic tumor-feeding arteries were detected by a mismatch between i.a. and i.v. CEUS in one case. Quantification of the reduction of microvascularization using TIC analysis may be a valuable periinterventional tool during DEB-TACE. Intraprocedural CEUS with i.a. and i.v. ultrasound contrast agent injection may help finding extrahepatic tumor-feeding arteries.