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© 2003 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 22:1163-1172 • 0278-4297

Early Assessment of the Therapeutic Response to Radio Frequency Ablation for Hepatocellular Carcinoma

Utility of Gray Scale Harmonic Ultrasonography With a Microbubble Contrast Agent

Dongil Choi, MD, Hyo K. Lim, MD, Won Jae Lee, MD, Seung Hoon Kim, MD, Young Han Kim, MD, Seong Hyun Kim, MD and Jae Hoon Lim, MD

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Address correspondence and reprint requests to Hyo K. Lim, MD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, South Korea. E-mail: hklim{at}smc.samsung.co.kr.

Objective. To evaluate the utility of gray scale harmonic ultrasonography with a microbubble contrast agent in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma. Methods. Seventy-five patients with 81 nodular hepatocellular carcinomas (1.3–4.8 cm) treated with percutaneous radio frequency ablation were evaluated with contrast-enhanced gray scale harmonic ultrasonography after intravenous bolus injection of a galactose-based microbubble contrast agent. The vascularity within the ablation zones was evaluated with a continuous scan for 3 to 5 seconds between 15 and 30 seconds after initiation of contrast agent injection. To evaluate the perfusion of the ablation zones, intermittent stimulated acoustic emission imaging was performed with a rapid sweeping technique from the end of the continuous scan. All patients underwent follow-up 3-phase helical computed tomography at 1 month after radio frequency ablation and were followed for at least 1 year. The results of contrast-enhanced ultrasonography were compared with those of follow-up computed tomography in terms of the presence or absence of residual unablated tumors. Results. In 10 (12%) of the 81 treated hepatocellular carcinomas, contrast-enhanced ultrasonography showed either nodular or crescentic enhancing foci at the margins of ablation zones, suggesting residual unablated tumors. Contrast-enhanced computed tomography obtained 1 month after radio frequency ablation confirmed the residual unablated tumors in the same 10 lesions. Diagnostic agreement between 1-month follow-up computed tomography and contrast-enhanced ultrasonography was achieved in all 81 cases (100%). Conclusions. Contrast-enhanced gray scale harmonic ultrasonography can be a reliable alternative to contrast-enhanced computed tomography in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma.

Key Words: computed tomography • contrast media • harmonic ultrasonography • liver neoplasms • radio frequency ablation

Abbreviations: CHA, Coded Harmonic Angio • CT, computed tomography




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