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© 2002 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 21:391-401 • 0278-4297

Article

Assessment of Therapeutic Response in Hepatocellular Carcinoma Treated With Percutaneous Radio Frequency Ablation

Comparison of Multiphase Helical Computed Tomography and Power Doppler Ultrasonography With a Microbubble Contrast Agent

Dongil Choi, MD, Hyo K. Lim, MD, Seung Hoon Kim, MD, Won Jae Lee, MD, Hyun-Jung Jang, MD, Hana Kim, MD, Soon Jin Lee, MD and Jae Hoon Lim, MD

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address correspondence and reprint requests to Hyo K. Lim, MD, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.

Objective. To compare the results of multiphase helical computed tomography and power Doppler ultrasonography with a microbubble contrast agent in the assessment of the therapeutic response to radio frequency ablation in hepatocellular carcinoma. Methods. In 66 patients with 73 nodular hepatocellular carcinomas ranging from 1.0 to 4.0 cm (mean, 2.6 cm) in diameter, contrast-enhanced power Doppler ultrasonography was performed after intravenous bolus injection of a galactose-based microbubble contrast agent before and after radio frequency ablation. The results of the studies were compared with the findings of follow-up 3-phase helical computed tomography. All patients were regularly followed up with computed tomography for more than 1 year (range, 13–19 months). Results. In 8 (11%) of 73 hepatocellular carcinomas, immediate follow-up computed tomography obtained within 2 hours after radio frequency ablation showed focal enhancing portions within the treated lesions, suggesting residual non-necrotic tumors. All 8 of these tumors had intratumoral flow signals on contrast-enhanced power Doppler ultrasonography. The diagnostic agreement between computed tomography and contrast-enhanced power Doppler ultrasonography was achieved in 100%. Among the remaining 65 hepatocellular carcinomas with the absence of residual tumors at both immediate follow-up computed tomography and contrast-enhanced power Doppler ultrasonography, subsequent follow-up computed tomography showed local regrowth at the margins of 10 lesions (15%). Conclusions. The results of contrast-enhanced power Doppler ultrasonography closely correlated with those of immediate follow-up computed tomography for detecting residual tumors in hepatocellular carcinomas treated with radio frequency ablation. Both techniques, however, showed a limitation in detecting small or microscopic residual tumors and in predicting local regrowth in the treated lesions.

Abbreviations: CT, computed tomography • MR, magnetic resonance • PDUS, power Doppler ultrasonography

Key Words: liver neoplasms • radio frequency ablation • ultrasonography • contrast media • power Doppler studies • computed tomography




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