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Evaluation of Response after High - Intensity Focused Ultrasound ablation of Hepatocellular Carcinoma: Utility of Contrast - enhanced Sonography

Ling Huo;Shan - Shan Yin;Hui Zhang;Li-Ping Bao;Min - Hua Chen Department of Ultrasound;Peking University School of Oncology;Beijing;100036;P. R. China

  Objective: The purpose of this study was to evaluate the feasibility and usefulness of contrast - enhanced ultrasound in assessing the therapeutic response of HIFU ablation of hepatocellular carcinoma (HCC). Methods: Five patients with HCC were administrated single session HIFU treatment (Chongqing Haifu Technology Co. , Ltd. , Chongqing, China). The average size of the tumors is 7 cm (range 6 to 9cm). Each patient was given contrast - enhanced ultrasound (SonoVue, Bracco, Italy) with a low mechanical index and magnetic resonance imaging ( MRI) examinations before and one month after the treatment. The fol- low-up was carried out every 3 months after the treatment. MRI was used as the gold standard. Results: All tumors demonstrated enhancement of various degrees in the arterial phase and quick washing - out in the portal and late phases when the ultrasound contrast agent was used before the treatment. Two cases illustrated obvious patched or papillary enhancement patterns in arterial phase at the peripheral of the tumors at follow - up of the 1 st month, which implied the existence of residual tumors. One of the three who did not show enhancement at the1 st month was detected partially peripheral enhancement in arterial phase and wash - out in late phase at the 4th month. The same result was obtained by the MRI images to confirm recurrences in the two cases. One patient did not show any enhancement by the contrast ultrasound examinations at the 7th month. The MRI images showed no enhanced signals in arterial, portal, or delayed phase either. Complete necrosis occurred after the HIFU treatment in this patient. Conclusions: The contrast enhanced ultrasound could be a feasible and useful method in evaluating the tumor response after HIFU treatment, which might be comparable to MRI. Further studies on the sensitivity and specificity of this method in large samples are going on.……