Abstract
The aim of this study was to assess the usefulness of contrast-enhanced ultrasound (CEUS) for predicting the therapeutic efficacy of transarterial chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC). Thirty-two patients with HCC who underwent DEB-TACE were enrolled in this study. Enhancement patterns of vascular phase images on CEUS were compared before and within 3 days after DEB-TACE, and the patterns after DEB-TACE were classified as follows: Pattern A, no enhancement; Pattern B, peripheral ring enhancement; Pattern C, partial enhancement within or peripheral to tumors, and Pattern D, reduced or unchanged enhancement in the whole tumor. Enhancement patterns in all lesions and contrast-enhanced computed tomography (CECT) findings after DEB-TACE were compared statistically. The treatment response of DEB-TACE was evaluated using the Modified Response Evaluation Criteria in Solid Tumors (mRECIST) by CECT. The enhancement patterns on CEUS performed within 3 days after DEB-TACE were defined as Pattern A in 17 cases, B in 7, C in 13, and D in 2. The complete response rates at one month after treatment were 94.1% (16/17 lesions) for Pattern A, 85.7% (6/7) for B, 15.4% (2/13) for C, and 50% (1/2) for D. The response rates were significantly higher for lesions with Pattern A compared to those with Pattern C at one month (p = 0.009) and 12 months (p < 0.001) after treatment, and significantly higher for lesions with Pattern B compared to those with Pattern C at 12 months after treatment (p = 0.031). Comparisons between other patterns showed no significant differences. CEUS immediately after DEB-TACE may allow early assessment of therapeutic efficacy, with findings of no enhancement or peripheral ring enhancement suggesting a positive outcome.
Highlights
Contrast-enhanced ultrasound (CEUS) is a technique that enables tumor visualization without the use of ionizing radiation or the risk of nephrotoxicity associated with contrast-enhanced computed tomography (CECT) [1]
We examined enhancement patterns on contrast-enhanced ultrasound (CEUS) performed soon after Drug-eluting beads (DEBs)-Transarterial chemoembolization (TACE) as potential predictors of therapeutic efficacy of DEB-TACE in patients with hepatocellular carcinoma (HCC)
The enhancement patterns on CEUS performed within 3 days after DEB-TACE were defined as Pattern A in 17 cases, Pattern B in 7 cases (Figure 2), Pattern C in 13 cases, and Pattern D in 2 cases
Summary
Contrast-enhanced ultrasound (CEUS) is a technique that enables tumor visualization without the use of ionizing radiation or the risk of nephrotoxicity associated with contrast-enhanced computed tomography (CECT) [1]. CEUS is useful for the assessment of the hemodynamics of hepatic tumors and surrounding hepatic parenchyma in real time. Drug-eluting beads (DEBs) are polyvinyl alcohol-based microspheres that can be loaded with anthracycline drugs, such as doxorubicin [4]. Transarterial chemoembolization (TACE) with DEB (DEB-TACE) is used in catheter-based locoregional therapy, which takes advantage of the arterial supply to HCC and spares the surrounding hepatic parenchyma, which receives most of its blood supply from the portal vein [5,6]. When injected through a catheter or microcatheter at the tumor site, DEBs act as embolic material, causing tumor ischemia, but they release drugs in a sustained and controlled manner [7]
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