Contrast-enhanced ultrasound evaluation of residual blood flow to hepatocellular carcinoma after treatment with transarterial chemoembolization using drug-eluting beads: a prospective study.
OBJECTIVES
To evaluate the accuracy and change over time of contrast-enhanced ultrasound (US) imaging for assessing residual blood flow after transarterial chemoembolization of hepatocellular carcinoma with drug-eluting beads at 2 different follow-up intervals.


METHODS
Data from 16 tumors treated by transarterial chemoembolization with drug-eluting beads were successfully obtained. As part of the study, patients provided consent to undergo contrast-enhanced US examinations the morning before embolization, 1 to 2 weeks after embolization, and the morning before follow-up contrast-enhanced magnetic resonance imaging (MRI) or computed tomography (CT) (1 month after embolization). Blinded review of contrast-enhanced US and MRI/CT studies were performed by 2 radiologists who evaluated residual flow as no change, partial change, or no residual flow. Inter- and intra-reader variability rates were calculated before discordant individual reads were settled by consensus.


RESULTS
The only adverse event reported during the contrast-enhanced US examinations was a single episode of transient back pain. Contrast-enhanced US at 1 to 2 weeks after embolization (n = 14) resulted in 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Contrast-enhanced US 1 month after embolization (n = 15) resulted in 75% sensitivity, 100% specificity, 100% positive predictive value, 92% negative predictive value, and 93% accuracy. Inter-reader agreement was 86% for contrast-enhanced US at 1 to 2 weeks, 93% for contrast-enhanced US at 1 month, and 100% for contrast-enhanced MRI/CT at 1 month, whereas intra-reader agreement was 71% for contrast-enhanced US at 1 to 2 weeks, 87% for contrast-enhanced US at 1 month, and 91% for MRI/CT.


CONCLUSIONS
Contrast-enhanced US imaging at 1 to 2 weeks after the procedure may be a viable alternative to MRI/CT for evaluating residual blood flow after transarterial chemoembolization with drug-eluting beads, albeit with a higher degree of reader variability.
['Shaw|Colette M|CM|', 'Eisenbrey|John R|JR|', 'Lyshchik|Andrej|A|', "O'Kane|Patrick L|PL|", 'Merton|Daniel A|DA|', 'Machado|Priscilla|P|', 'Pino|Laura|L|', 'Brown|Daniel B|DB|', 'Forsberg|Flemming|F|']
D000368:Aged D000970:Antineoplastic Agents D006528:Carcinoma, Hepatocellular D016461:Chemoembolization, Therapeutic D003287:Contrast Media D003692:Delayed-Action Preparations D004317:Doxorubicin D054855:Drug-Eluting Stents D005260:Female D006490:Hemostatics D006801:Humans D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D009389:Neovascularization, Pathologic D015588:Observer Variation D055420:Perfusion Imaging D011379:Prognosis D011446:Prospective Studies D016896:Treatment Outcome D014463:Ultrasonography
contrast-enhanced ultrasound hepatocellular carcinoma transarterial chemoembolization drug-eluting beads