Contrast-Enhanced Subtraction Harmonic Sonography for Evaluating Treatment Response in Patients with Hepatocellular Carcinoma

• Published in: American journal of roentgenology (1976) Vol. 176; no. 3; pp. 661 - 666
• Main Authors: Ding, Hong, Kudo, Masatoshi, Onda, Hirokazu, Suetomi, Yoichiro, Minami, Yasunori, Maekawa, Kiyoshi
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.03.2001; American Roentgen Ray Society
• Subjects: Aged; Antibiotics, Antineoplastic - administration & dosage; Biological and medical sciences; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic; Contrast Media; Digestion. Liver. Biliary tract. Spleen. Pancreas; Epirubicin - administration & dosage; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver Neoplasms - diagnostic imaging; Liver Neoplasms - therapy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Polysaccharides; Radionuclide investigations; Sensitivity and Specificity; Subtraction Technique; Tomography, X-Ray Computed; Tumors; Ultrasonography; Sonography; Human; Subtraction; Treatment efficiency; Digestive diseases; Hepatic disease; Harmonic analysis; Hepatocellular carcinoma; Malignant tumor; Technique; Contrast media
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.176.3.1760661

Our objective was to assess the usefulness of contrast-enhanced subtraction harmonic sonography in evaluating the treatment response of patients with hepatocellular carcinoma. Thirty-two hepatocellular carcinoma lesions in 26 patients (age range, 44-85 years; mean age, 66 years) were examined with Levovist-enhanced intermittent harmonic imaging before and after therapy. A Toshiba Powervision 8000 was used. A subtraction image was obtained by digitally subtracting the last-frame harmonic image from the first-frame image when multishot mode was preset. Results of contrast-enhanced CT were compared with the results of subtraction harmonic imaging. Before therapy, an enhancement pattern of tumor vascularity was seen for 93.8% (30/32) of hepatocellular carcinoma nodules on subtraction harmonic imaging. After therapy, subtraction harmonic imaging showed 46.7% (14/30) enhancement (incomplete tumor necrosis) and 53.3% (16/30) no enhancement (complete tumor necrosis). When dynamic CT was the gold standard, the sensitivity, specificity, and accuracy of subtraction harmonic imaging were 93.3%, 100%, and 96.7%, respectively. Intratumoral flow signals in hepatocellular carcinoma after therapy on harmonic imaging were used as a guide to target additional percutaneous therapy. Digital subtraction contrast-enhanced harmonic imaging can depict tumor vascularity in hepatocellular carcinoma after therapy sensitively and accurately. Because it is easy to perform and provides real-time needle insertion guidance, it may be preferable to perform after localized therapy to monitor treatment response, which will reduce unnecessary CT scanning.