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© 2005 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 24:273-283 • 0278-4297

Evaluation Using Contrast-Enhanced Harmonic Gray Scale Sonography After Radio Frequency Ablation of Small Hepatocellular Carcinoma

Sonographic-Histopathologic Correlation

Manabu Morimoto, MD, Akinori Nozawa, MD, Kazushi Numata, MD, Kazuhito Shirato, MD, Kazuya Sugimori, MD, Atsushi Kokawa, MD, Naohiko Tomita, MD, Toshifumi Saitou, MD, Yukio Nakatani, MD, Toshio Imada, MD and Katsuaki Tanaka, MD

Gastroenterological Center (M.M., K.N., K.Sh., K.Su., A.K., N.T., T.S., T.I., K.T.) and Department of Pathology (A.N., Y.N.), Yokohama City University Medical Center, Yokohama, Japan.

Address correspondence and reprint requests to Katsuaki Tanaka, MD, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. E-mail: k_tanaka{at}urahp.yokohama-cu.ac.jp

Objective. To evaluate the usefulness of contrast-enhanced harmonic wideband gray scale sonographic images obtained after radio frequency–induced coagulation necrosis, we compared the morphologic and histopathologic characteristics of the ablated tumors with sonographic images of the tumors. Methods. Forty-eight patients with 72 hepatocellular carcinomas with a maximal diameter of 3 cm or less were treated percutaneously using radio frequency ablation. Six treated tumors in 4 patients were resected 1 month after ablation; the remaining 66 treated tumors were evaluated by a biopsy procedure performed with an 18-gauge fine needle 1 month after ablation. The excised tumors and biopsy specimens were then examined by histopathologic methods, and the findings were compared with those obtained on contrast-enhanced harmonic wideband gray scale sonography. Hematoxylin-eosin–stained specimens were inconclusive as to whether cellular viability remained; therefore, cell viability was determined by a positive result after histochemical (lactate dehydrogenase and nicotinamide adenine dinucleotide phosphate-diaphorase) staining. Results. Contrast-enhanced harmonic wideband gray scale sonography after radio frequency ablation showed residual tumor enhancement in 5 (6.9%) of the 72 tumors; the histopathologic results for these 5 tumors were also positive for tumor residue. The remaining 67 tumors (93.1%) did not show any residual tumor enhancement when examined by sonography; however, only 66 tumors did not reveal tumor residue when examined histopathologically. Contrast-enhanced harmonic wideband sonographic imaging provided results that were comparable with histopathologic findings, the criterion standard for diagnosis; the sensitivity and specificity of the sonographic images for the detection of residual tumor tissue in ablated tumors were 83.3% (5 of 6) and 100% (66 of 66), respectively. Conclusions. Contrast-enhanced harmonic wideband gray scale sonography is a potentially useful technique for evaluating the therapeutic effects of radio frequency ablation on hepatocellular carcinoma.

Key Words: contrast-enhanced sonography • hepatocellular carcinoma • pathologic findings • radio frequency ablation

Abbreviations: CT, computed tomography • MRI, magnetic resonance imaging • NADPH, nicotinamide adenine dinucleotide phosphate

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Copyright © 2005 by the American Institute of Ultrasound in Medicine.