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Ablation Therapy Guided by Contrast-Enhanced Sonography with Sonazoid for Hepatocellular Carcinoma Lesions Not Detected by Conventional Sonography

Gastroenterological Center (K.N., M.M., T.O., K.S., K.T.) and Department of Radiology (S.T.), Yokohama City University Medical Center, Yokohama, Japan; and Department of Radiology, Kinki University School of Medicine, Osaka, Japan (M.O.).

Address correspondence to Kazushi Numata, MD, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan. E-mail: kz-numa{at}zero.ad.jp

Objective. We evaluated the usefulness of contrast-enhanced harmonic gray scale sonography with a newly developed sonographic contrast medium as a means of guidance for percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography. Methods. We examined 85 patients with 108 hepatocellular carcinoma lesions that were identified as hypervascular by multidetector-row computed tomography by using contrast-enhanced harmonic gray scale sonography after injection of Sonazoid (GE Healthcare, Oslo, Norway), a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent. We scanned the whole liver by this modality at a low mechanical index in the late phase to detect lesions not detected by conventional sonography and then scanned the lesions again by this modality at a high mechanical index to visualize tumor vessels and enhancement. We also performed percutaneous ablation therapy guided by this modality to treat viable hepatocellular carcinoma lesions that could not be detected by conventional sonography. Results. Conventional sonography identified 90 (83%) of 108 hepatocellular carcinoma lesions; 15 (14%) additional viable lesions not detected by conventional sonography were detected in the late phase of contrast-enhanced harmonic gray scale sonography at a low mechanical index, and tumor vessels and enhancement were observed in the late phase at a high mechanical index. Contrast-enhanced harmonic gray scale sonography diagnosed 105 (97%) of the 108 viable hepatocellular carcinoma lesions, and 14 (93%) of the 15 lesions not detected by conventional sonography were successfully treated by percutaneous ablation therapy guided by this modality. Conclusions. Contrast-enhanced harmonic gray scale sonography is useful for guidance of percutaneous ablation therapy of hepatocellular carcinoma lesions not detected by conventional sonography.

Key Words: ablation therapy • contrast-enhanced sonography • hepatocellular carcinoma • Sonazoid

Abbreviations: CHA, coded harmonic angio • CPI, coded phase inversion • CT, computed tomography • RFA, radio frequency ablation

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