Intravenous contrast-enhanced Doppler sonography and intra-arterial carbon dioxide-enhanced sonography in the assessment of hepatocellular carcinoma vascularity before and after treatment

Abstract

To compare i.v. contrast-enhanced sonography (CEUS), power Doppler sonography (PDUS) and i.a. carbon dioxide-enhanced sonography (CO2US) in assessing hepatocellular carcinoma (HCC) vascularities before and after treatment. Differences between PDUS and CEUS with the aid of CO2US were also observed. In all, 43 patients with 67 histologically proved HCCs were examined with PDUS, CEUS, and CO2US. Among these tumors, 36 were HCCs before treatment and 31 were HCCs treated by transcatheter arterial chemoembolization or percutaneous ethanol injection or a combination of these two treatments. CO2US was used as the gold standard when comparing the PDUS and CEUS. Of the 36 untreated HCC tumors, 20 (55.6%) were hypervascular compared with the liver parenchyma at PDUS, 28 (77.8%) at CEUS, 31 (86.1%) at the early phase of CO2US and 32 (88.9%) at the late phase of CO2US. Of the 31 post-treatment HCCs, 11 (35.5%) showed hypervascularity at PDUS, 25 (80.6%) at CEUS, 25 (80.6%) at the early phase of CO2US and 26 (83.9%) at the late phase of CO2US. CO2US was superior to CEUS and CEUS was superior to PDUS for the detection of tumor vascularity in both untreated and treated HCCs. The duration of enhancement at CEUS was shorter than at CO2US. The ability of CO2US to detect additional small tumors was not possible with PDUS and CEUS.