Radiofrequency Ablation of Hepatocellular Carcinoma: Therapeutic Response Using Contrast-Enhanced Coded Phase-Inversion Harmonic Sonography
Yan Ling Wen1,2,
Masatoshi Kudo1,
Rong Qin Zheng1,3,
Yasunori Minami1,
Hobyung Chung1,
Yoichiro Suetomi1,
Hirokazu Onda1,
Masayuki Kitano1,
Toshihiko Kawasaki1 and
Kiyoshi Maekawa4
1 Department of Gastroenterology and Hepatology, Kinki University School of
Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.
2 Present address: Department of Ultrasound, The Second Affiliated Hospital, Sun
Yat-sen University, 107 Yanjiangxi Rd., Guangzhou 510-120, China.
3 Present address: Department of Ultrasound, The Third Affiliated Hospital, Sun
Yat-sen University, Shipai, Guangzhou 510-630, China.
4 Abdominal Ultrasound Unit, Kinki University School of Medicine, Osaka-Sayama,
Osaka 589-8511, Japan.
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Fig. 1. —Diagram illustrates safety margin of ablated peritumoral
liver tissue that is located between necrotic tumor and unablated liver
tissue. Safety margin appears as hypoattenuating area on three-phase dynamic
CT and as hypovascular area on contrast-enhanced imaging with coded harmonic
angio software (General Electric Medical Systems, Milwaukee, WI), similar to
ablated tumor.
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Fig. 2A. —77-year-old woman with 1.5-cm hepatocellular carcinoma nodule
in segment VIII. Before treatment, subcostal scanning, which was used with
contrast-enhanced coded harmonic angio software (General Electric Medical
Systems, Milwaukee, WI), shows strong gray-scale blood signals
(arrows) within entire tumor on interval-delay scanning.
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Fig. 2B. —77-year-old woman with 1.5-cm hepatocellular carcinoma nodule
in segment VIII. Arterial phase dynamic CT scan obtained before radiofrequency
ablation shows hepatocellular carcinoma (arrow) as homogenous
high-attenuated tumor.
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Fig. 2C. —77-year-old woman with 1.5-cm hepatocellular carcinoma nodule
in segment VIII. One week after first session of radiofrequency ablation,
contrast-enhanced coded harmonic angio reveals strongly enhanced tumor
parenchymal stain (arrowheads) after administration of contrast agent
Levovist (Schering, Berlin, Germany) in area of tumor that suggested
incomplete response to radiofrequency ablation.
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Fig. 2D. —77-year-old woman with 1.5-cm hepatocellular carcinoma nodule
in segment VIII. Arterial phase of dynamic CT scan obtained same day as coded
harmonic angio (C) confirms residual tumor by high attenuation in
portion of tumor (arrowheads).
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Fig. 2E. —77-year-old woman with 1.5-cm hepatocellular carcinoma nodule
in segment VIII. On contrast-enhanced sonogram obtained with coded harmonic
angio 1 week after second session of radiofrequency ablation, perfusion defect
area of tumor is shown that suggests complete effect of radiofrequency
ablation.
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Fig. 2F. —77-year-old woman with 1.5-cm hepatocellular carcinoma nodule
in segment VIII. On arterial phase dynamic CT scan acquired same day as
E, lack of enhancement in area of tumor is shown and confirms treatment
response to be complete.
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Fig. 3A. —56-year-old man with 1.0-cm hepatocellular carcinoma in
segment VI. Before radiofrequency ablation, contrast-enhanced sonogram
obtained with coded harmonic angio software (General Electric Medical Systems,
Milwaukee, WI) shows few tumor vessels within hepatocellular carcinoma
(arrows) in early arterial phase.
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Fig. 3B. —56-year-old man with 1.0-cm hepatocellular carcinoma in
segment VI. Tumor was shown to be high attenuating on arterial phase dynamic
CT scan (arrowhead).
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Fig. 3C. —56-year-old man with 1.0-cm hepatocellular carcinoma in
segment VI. After two sessions of radiofrequency ablation, coded harmonic
angio of tumor parenchymal stain shows larger perfusion defect area
(arrows) than ablated tumor (circle), which suggests large
enough safety margin.
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Fig. 3D. —56-year-old man with 1.0-cm hepatocellular carcinoma in
segment VI. On arterial phase dynamic CT scan, low-attenuation area apparently
larger (5 mm) than ablated tumor (arrow) was identified, and complete
response with enough safety margin was confirmed.
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Fig. 4A. —Flow charts show therapeutic strategy of radiofrequency
ablation. Before introduction of contrast-enhanced imaging with coded harmonic
angio software (General Electric Medical Systems, Milwaukee, WI), dynamic CT
must be performed after each session of radiofrequency ablation to assess
therapeutic response.
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Fig. 4B. —Flow charts show therapeutic strategy of radiofrequency
ablation. After introduction of contrast-enhanced imaging with coded harmonic
angio, residual tumor can be clearly identified on sonographic imaging plane
that can be used as effective guidance for further radiofrequency ablation.
Dynamic CT was performed only for assessing safety margin when treatment was
evaluated to be complete on contrast-enhanced coded harmonic angio.
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Copyright © 2003 by the American Roentgen Ray Society.
