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Therapeutic Response Evaluation of Malignant Hepatic Masses Treated by Interventional Procedures With Contrast-Enhanced Agent Detection Imaging

Department of Radiology, Chonbuk National University Hospital, Jeonju, South Korea (J.H.Y., C.S.K.); and Department of Radiology, Seoul National University Hospital, Seoul, South Korea (J.M.L.).

Address correspondence and reprint requests to Jeong Min Lee, MD, Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea. E-mail:leejm{at}radcom.snu.ac.kr

Objective. To assess the usefulness of microbubble contrast-enhanced agent detection imaging in evaluating the therapeutic response of malignant hepatic masses to treatment with interventional procedures. Methods. Fifty-eight patients with 68 hepatocellular carcinomas and 6 metastases who were treated with interventional procedures were evaluated with SH U 508A-enhanced agent detection imaging and helical computed tomography. Helical computed tomography was also performed to help establish the outcome of therapy with unenhanced computed tomography 2 weeks after transcatheter arterial chemoembolization and with dynamic contrast-enhanced computed tomography 1 day after radio frequency ablation or percutaneous ethanol injection. The studies were reviewed separately and randomly, and the sensitivity and specificity of agent detection imaging for detection of viable tumor residue were determined by follow-up imaging performed at least 3 months later. Results. Follow-up computed tomography or magnetic resonance imaging revealed complete tumor responses in 44 (59.5%) of 74 cases after the therapeutic procedures. The sensitivity of agent detection imaging was 94.7% after transcatheter arterial chemoembolization and 72.7% after radio frequency ablation and percutaneous ethanol injection. The specificity of agent detection imaging for the detection of residual tumors was 80% after transcatheter arterial chemoembolization and 79.2% after radio frequency ablation and percutaneous ethanol injection. The false-positive rate for agent detection imaging in cases of radio frequency ablation or percutaneous ethanol injection was 20.8% (5 of 24), resulting from reactive hyperemia or vascularity within the safety margin. In the assessment of the therapeutic effects, the concordance of contrast-enhanced agent detection imaging with helical computed tomography was statistically significant after transcatheter arterial chemoembolization (P < .00001) and radio frequency ablation or percutaneous ethanol injection (P < .02). Conclusions. Contrast-enhanced agent detection imaging proved useful and as effective as helical computed tomography for evaluating the therapeutic effects of interventional therapeutic procedures for malignant hepatic masses.

Key Words: agent detection imaging • contrast media • liver • neoplasms • radiography, interventional • ultrasonography

Abbreviations: ADI, agent detection imaging • CT, computed tomography • HCC, hepatocellular carcinoma • MI, mechanical index • MRI, magnetic resonance imaging • PEI, percutaneous ethanol injection • RF, radio frequency • TACE, transcatheter arterial chemoembolization

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