ABSTRACT
PURPOSE: To evaluate tumor perfusion by means of dynamic contrast-enhanced ultrasonography (DCEUS) and aggregated time intensity curves (TICs) after transarterial chemoembolization with degradable starch microspheres (DSM-TACE). MATERIAL AND METHODS: 18 patients underwent 36 DCEUS examinations conducted via contrast agent application before and after DSM-TACE. Based on time intensity curves (TICs), we analyzed the microcirculation of the embolized HCC lesions with a dedicated perfusion software. RESULTS: Signal intensity was significantly reduced (p ≤ 0.001) after DSM-TACE at all time points measured. The mean signal intensity after 5, 10, 15, 20 and 25 s was 375.18 ± 16.41, 455.66 ± 17.92, 294.47 ± 19.91, 246.51 ± 20.99 and 173.45 ± 25.80 before TACE and 49.47 ± 2.43, 49.51 ± 2.40, 37.40 ± 2.45, 27.48 ± 2.65 and 27.96 ± 3.01 after TACE. CONCLUSION: In this study, tumor perfusion could be accurately evaluated by means of DCEUS and aggregated TICs after DSM-TACE.
Subject(s)
Carcinoma, Hepatocellular/diagnostic imaging , Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic/methods , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/therapy , Starch/administration & dosage , Carcinoma, Hepatocellular/blood supply , Contrast Media , Feasibility Studies , Female , Humans , Liver Neoplasms/blood supply , Male , Middle Aged , Prospective Studies , UltrasonographyABSTRACT
PURPOSE: To evaluate the time dependent changes of microcirculation in hepatocellular carcinoma (HCC) lesions during degradable starch microsphere (DSM)-TACE using contrast enhanced ultrasound (CEUS). MATERIALS AND METHODS: A total of 48 CEUS examinations were performed (1-5 MHz, convex probe) in 6 selected patients who underwent DSM-TACE with EmboCept®S for the treatment of HCC lesions. I.v. application of ultrasound contrast media was performed before and 24 hours post embolization. In addition i.a. contrast application was performed via the angiographic catheter right before and after the embolization and during a follow up time of 2 hours every 30 minutes. The capillary circulation of the treated HCC lesions was analyzed and quantitative perfusion analysis was performed using a perfusion software by two experienced radiologists in consensus. RESULTS: A significantly reduced microvascularization was seen right after DSM-TACE in all cases using CEUS. The reduction of PEAK, RBV (regional blood volume) and RBF (regional blood flow) compared to preembolization values was highly significant. Mean PEAK was 34.3 ± 13.1 prior to embolization and 9.4 ± 9.1 post embolization (p < 0.001). Mean RBV was 446.5 ± 122.4 prior to embolization and 70.9 ± 23.8 post embolization (p < 0.001). The corresponding figures for RBF were 34.7 ± 13.4 prior- and 4.8 ± 3.4 post embolization (p < 0.001). During follow up a stepwise revascularization of the lesions was documented: 90 minutes post embolization perfusion parameters were not significantly different from prae-embolization values. CONCLUSION: In this feasibility study, capillary perfusion quantification of HCC lesions after DSM-TACE could be demonstrated using CEUS. Using quantitative perfusion analysis it was possible to quantify the transient embolizing effect of DSM-TACE.
Subject(s)
Carcinoma, Hepatocellular/blood supply , Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic/methods , Liver Neoplasms/blood supply , Liver Neoplasms/therapy , Starch/administration & dosage , Aged , Carcinoma, Hepatocellular/diagnostic imaging , Contrast Media , Feasibility Studies , Humans , Liver Neoplasms/diagnostic imaging , Microcirculation , Middle Aged , Treatment Outcome , UltrasonographyABSTRACT
PURPOSE: To evaluate therapeutic efficacy of degradable starch microsphere (DSM)-TACE in hepatocellular carcinoma (HCC) using Dynamic Contrast-Enhanced Ultrasonography (DCE-US) based perfusion analysis. MATERIALS AND METHODS: A total of 60 DCE-US examinations were performed in 15 selected patients who underwent DSM-TACE with EmboCept®S for the treatment of advanced HCC. DCE-US was performed via i.v. application of ultrasound contrast media before and 24 hours post embolization. In addition DCE-US was performed with i.a. contrast application via the angiographic catheter right before and after the embolization. Microcirculation of embolized HCC lesions was quantified using a dedicated perfusion software by two experienced radiologists in consensus. RESULTS: Significant reduction of microvascularization (PE, WiAUC and WiR) was seen right after DSM-TACE and during 24 hour follow-up. Mean PE was 342.22 ± 97.80 prior to embolization, 59.28 ± 29.74 post embolization (p = 0.019) and 18.83 ± 7.03 during follow-up (p ≤ 0.01). Mean WiAUC was 1103.21 ± 432.05 prior to embolization 267.69 ± 151.80 post embolization (p = 0.023) and 105.10 ± 44.43 during 24 hour follow-up (p ≤ 0.01). The corresponding values for WiR were 224.91 ± 57.97 prior-, 38.14 ± 18.80 post embolization (p = 0.034) and 6.97 ± 2.68 during follow up (p ≤ 0.01). CONCLUSION: In this study, therapeutic efficacy of DSM-TACE in HCC using DCE-US based perfusion analysis could be demonstrated.
