Contrast-enhanced ultrasound (CEUS) with second-generation contrast agents performed 1-month after HCC treatment is almost as sensitive as contrast-enhanced computed tomography (CECT) in depicting the residual tumor. However, the efficacy of CEUS performed early after the procedure is still debated.
We evaluated the diagnostic accuracy of CEUS for the assessment of tumour response shortly after locoregional therapy in patients with unresectable HCC.
Ninety-four patients with 104 HCC lesions who were scheduled to receive PEI, RFA, TACE or combined treatment were enrolled in this study. With CECT at 1-month as the reference standard, the diagnostic accuracy of CEUS performed 48-hours after the procedure was evaluated. Patients were followed-up to look for tumor or disease progression.
Based on CECT findings, 43/104 lesions were diagnosed as having residual viability after 1 month. CEUS performed 48-hours after treatment detected residual tumor in 34/43 nodules with treatment failure at CECT with a sensitivity, specificity, PPV, NPV and accuracy of 79.1%, 96.7%, 94.4%, 86.8% and 89% respectively. There was a high degree of concordance between CEUS and CECT (kappa coefficient=0.78). An hyperemic halo was detectable in 35 lesions without a statistically significant difference between concordant and discordant cases. In patients with uninodular disease responders according to 48 hours CEUS had a significantly longer mean overall survival and time to progression compared to non-responders.
CEUS performed 48 hours after treatment can be considered a reliable modality for the evaluation of the real extent of necrosis and has prognostic value in the assessment of hepatocellular carcinoma.
- interobserver agreement
- intraobserver agreement
- thyroid nodule
- thyroid ultrasound report
- ultrasound classification systems
- ultrasound features