Research Article: Color coded perfusion imaging with contrast enhanced ultrasound (CEUS) for post-interventional success control following trans-arterial chemoembolization (TACE) of hepatocellular carcinoma

Date Published: June 10, 2019

Publisher: Public Library of Science

Author(s): Janine Rennert, Isabel Wiesinger, Andreas Schicho, Lukas Philip Beyer, Philipp Wiggermann, Christian Stroszczynski, Ernst Michael Jung, Gianfranco D. Alpini.


Evaluation of an external color coded perfusion quantification software with CEUS for the post-interventional success control following TACE in patients with HCC.

31 patients (5 females, 26 males, age range 34–82 years, mean 66.8 years) with 59 HCC lesions underwent superselective TACE using DSM Beads between 01/2015 and 06/2018. All patients underwent CEUS by an experienced examiner using a convex multifrequency probe (1–6 MHz) within 24 hours following TACE to detect residual tumor tissue. Retrospective evaluation using a perfusion quantification software regarding pE, TTP, mTT, Ri and WiAUC in the center of the lesion, the margin and surrounding liver.

In all lesions, a post-interventional visual reduction of the tumor microvascularization was observed. Significant differences between center of the lesion vs. margin and surrounding liver were found regarding peak enhancement (867.8 ± 2416 center vs 2028 ± 3954 margin p<0.005) and center 867.8 ± 2416 vs 2824 ± 4290 surrounding liver, p<0.0001)). However, no significant differences were found concerning Ri, WiAuC, mTT and TTP. CEUS with color- coded perfusion imaging is a valuable supporting tool for post-interventional success control following TACE of liver lesions. Peak enhancement seems to be the most valuable parameter.

Partial Text

Liver lesions are the sixth most common cancer (approximately 750,000 new cases per year) and currently represent the third most common cause of cancer-related deaths worldwide. Hepatocellular carcinoma (HCC) shows an increasing incidence and generates over 90% of all primary hepatic cancers, thus representing a major healthcare problem [1].

Whereas surgical resection and ablation are widely accepted for curative care, trans-arterial chemoembolization remains the standard treatment option in patients with non-resectable HCC or if an ablative technique is not possible. The long-term results regarding tumor recurrence and overall survival are favorable compared to best supportive care [22]. Assessment of tumor response following interventional treatment is crucial for determination of treatment efficiency and further strategies.