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Using Contrast-Enhanced Sonography to Assess the Effectiveness of Transcatheter Arterial Embolization for Hepatocellular Carcinoma

Kazushi Numata1, Katsuaki Tanaka1, Takayoshi Kiba1, Satoru Saito1, Tetsuo Isozaki1, Koji Hara1, Manabu Morimoto1, Hisahiko Sekihara1, Hiromi Yonezawa2 and Toru Kubota3

1 Third Department of Internal Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
2 Clinical Laboratory, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama 236-0004, Japan.
3 Second Department of Surgery, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama 236-0004, Japan.



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  		Fig. 1A. —80-year-old man with Child's class B cirrhosis and hepatocellular carcinoma (maximum diameter, 20 mm) in superior anterior segment of right lobe of liver. Arterial phase contrast-enhanced wideband harmonic gray-scale sonogram after transcatheter arterial embolization shows tumor and tumor margin (arrowheads). Note hypervascular area within tumor (arrow).

 


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  		Fig. 1B. —80-year-old man with Child's class B cirrhosis and hepatocellular carcinoma (maximum diameter, 20 mm) in superior anterior segment of right lobe of liver. Portal phase contrast-enhanced wideband harmonic gray-scale sonogram shows hypervascular area (arrow) in tumor. Enhancement of liver parenchyma is also seen.

 


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  		Fig. 2A. —83-year-old woman with Child's class A cirrhosis and hepatocellular carcinoma (maximum diameter, 40 mm) in superior anterior segment of right lobe of liver. Before-treatment arterial phase contrast-enhanced wideband harmonic gray-scale sonogram shows tumor and tumor margin (arrowheads). Note intratumoral vessels that are tortuous centrally in tumor (arrow).

 


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  		Fig. 2B. —83-year-old woman with Child's class A cirrhosis and hepatocellular carcinoma (maximum diameter, 40 mm) in superior anterior segment of right lobe of liver. Before-treatment portal phase contrast-enhanced wideband harmonic gray-scale sonogram shows tumor and tumor margin (arrowheads). Note that homogeneous tumor enhancement is almost same as that of liver parenchyma.

 


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  		Fig. 3C. —63-year-old woman with Child's class B cirrhosis and hepatocellular carcinoma (maximal diameter 30 mm) in lateral segment of left lobe of liver. Contrast-enhanced CT scan obtained after six percutaneous ethanol injection treatments does not show high-attenuation area. Arrowheads indicate tumor margin.

 


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  		Fig. 3D. —63-year-old woman with Child's class B cirrhosis and hepatocellular carcinoma (maximal diameter 30 mm) in lateral segment of left lobe of liver. Portal phase contrast-enhanced wideband harmonic gray-scale sonogram obtained after six percutaneous ethanol injection treatments shows hypervascular area (arrow) in tumor.

 


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  		Fig. 2D. —83-year-old woman with Child's class A cirrhosis and hepatocellular carcinoma (maximum diameter, 40 mm) in superior anterior segment of right lobe of liver. Portal phase contrast-enhanced wideband harmonic gray-scale sonogram after transcatheter arterial embolization shows hypervascular area (arrow) in tumor. Enhancement of liver parenchyma is also seen.

 


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  		Fig. 3B. —63-year-old woman with Child's class B cirrhosis and hepatocellular carcinoma (maximal diameter 30 mm) in lateral segment of left lobe of liver. Portal phase contrast-enhanced wideband harmonic gray-scale sonogram obtained after transcatheter arterial embolization shows tumor and tumor margin (arrowheads). Lesions that correspond to deposition of iodized oil (arrows) do not show hypervascular enhancement; however, surrounding lesions, free of iodized oil deposition, show hypervascular enhancement.

 


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  		Fig. 3A. —63-year-old woman with Child's class B cirrhosis and hepatocellular carcinoma (maximal diameter 30 mm) in lateral segment of left lobe of liver. Contrast-enhanced CT scan obtained after transcatheter arterial embolization shows incomplete deposition of iodized oil and surrounding high-attenuation area (arrow) in tumor and tumor margin (arrowheads).

 


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  		Fig. 2C. —83-year-old woman with Child's class A cirrhosis and hepatocellular carcinoma (maximum diameter, 40 mm) in superior anterior segment of right lobe of liver. Contrast-enhanced CT scan obtained after transcatheter arterial embolization shows incomplete deposition of iodized oil, such that evaluation of tumor viability is not possible because of iodized oil accumulation in tumor (arrowheads).

 


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  		Fig. 2E. —83-year-old woman with Child's class A cirrhosis and hepatocellular carcinoma (maximum diameter, 40 mm) in superior anterior segment of right lobe of liver. Portal phase contrast-enhanced wideband harmonic gray-scale sonogram obtained after additional percutaneous ethanol injection therapy shows complete disappearance of hypervascular area within tumor. Enhancement of liver parenchyma is seen.

 


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  		Fig. 3E. —63-year-old woman with Child's class B cirrhosis and hepatocellular carcinoma (maximal diameter 30 mm) in lateral segment of left lobe of liver. Portal phase contrast-enhanced wideband harmonic gray-scale sonogram obtained after seven percutaneous ethanol injection treatments shows that hypervascular area in tumor is no longer seen.

 

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