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Hepatocellular Carcinoma Treated with Radiofrequency Ablation

Comparison of Pulse Inversion Contrast-Enhanced Harmonic Sonography, Contrast-Enhanced Power Doppler Sonography, and Helical CT

M. Franca Meloni1, S. Nahum Goldberg2, Tito Livraghi1, Fabrizio Calliada3, Paolo Ricci4, Michele Rossi4, Dario Pallavicini5 and Rodolfo Campani5

1 Servizio di Radiologia, Ospedale Civile via Cesare, Battisti 25, Vimercate, Milano, Italy.
2 Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.
3 Servizio di Radiologia, Ospedale Maggiore, Largo Donatori Sangue 1, Lodi, Italy.
4 Istituto di Radiologia, Universita Degli Studi di Roma "La Sapienza" Roma, Italy.
5 Istituto di Radiologia, Universita di Pavia Piazzale, Golgi 1, Pavia, Italy.



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  		Fig. 1A. —72-year-old man with 4.5-cm hepatocellular carcinoma treated 4 months before study using radiofrequency ablation. Gray-scale sonogram obtained without contrast material shows uniformly heterogeneous, slightly hypoechoic lesion, as marked by electronic calipers.

 


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  		Fig. 1B. —72-year-old man with 4.5-cm hepatocellular carcinoma treated 4 months before study using radiofrequency ablation. Power Doppler sonogram obtained during same session as A after administration of SH-508 sonographic contrast material shows patches of color signal in lesion (arrow). This finding indicates residual viable tumor.

 


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  		Fig. 1C. —72-year-old man with 4.5-cm hepatocellular carcinoma treated 4 months before study using radiofrequency ablation. Pulse inversion sonogram confirms presence of crescent-shaped region of residual viable tumor (arrows). Region of residual tumor identified by pulse inversion is greater than that observed with power Doppler sonography.

 


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  		Fig. 1D. —72-year-old man with 4.5-cm hepatocellular carcinoma treated 4 months before study using radiofrequency ablation. Arterial phase CT scan obtained on same day as A-C sonographic study shows residual hypervascular rim (straight arrows) of viable tumor, that corresponds in morphology and size to region of tumor identified using pulse inversion sonogram. Nonenhancing, hypodense portion of tumor (curved arrow) is adequately ablated.

 


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  		Fig. 2A. —65-year-old man with 3.2-cm hepatocellular carcinoma treated 4 months before study using radiofrequency ablation. Sagittal power Doppler sonogram obtained after administration of SH-508 sonographic contrast material shows no color signal (greater than baseline static) within lateral, hyperechoic portion of lesion (large arrow). Small arrows point to vessels adjacent to lesion.

 


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  		Fig. 2B. —65-year-old man with 3.2-cm hepatocellular carcinoma treated 4 months before study using radiofrequency ablation. Pulse inversion image identifies presence of peripheral region of enhancement, denoting residual viable tumor (arrows) requiring treatment.

 


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  		Fig. 2C. —65-year-old man with 3.2-cm hepatocellular carcinoma treated 4 months before study using radiofrequency ablation. Arterial phase CT scan obtained 1 day after sonographic study confirms presence of residual focus of enhancing viable tumor (arrow). This area was at lower margin of tumor, and hence corresponded in morphology, size, and location to region of tumor identified using pulse inversion sonography.

 


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  		Fig. 3A. —58-year-old man with 2.2-cm hepatocellular carcinoma treated 4 months before study using radiofrequency ablation. Pulse inversion sonograms obtained 20, 30, and 40 sec (left to right) after administration of SH-508 sonographic contrast material identify presence of bilobed focus of enhancement at periphery of lesion (solid straight arrows). Progressive enhancement of lesions is observed at 40 sec. Arterial feeding vessel is well visualized on earlier scans (open arrows), with enhancement of venous structures identified only at 40 sec (curved arrows).

 


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  		Fig. 3B. —58-year-old man with 2.2-cm hepatocellular carcinoma treated 4 months before study using radiofrequency ablation. Arterial phase CT scan obtained on same day as sonographic study (A) confirms bilobed morphology of focus of enhancing residual viable tumor (small arrows). Non-enhancing hypodense portion of tumor is adequately ablated. Second hypervascular tumor, which was subsequently ablated, is also identified (large arrow).

 

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