Contrast-enhanced power Doppler sonography and helical computed tomography for assessment of vascularity of small hepatocellular carcinomas before and after percutaneous ablation
✍ Scribed by Ramon Vilana; Josep M. Llovet; Luis Bianchi; Marcelo Sanchez; Mario Pagés; Margarita Sala; Rosa Gilabert; Carlos Nicolau; Angeles Garcia; Carmen Ayuso; Jordi Bruix; Concepció Bru
- Publisher
- John Wiley and Sons
- Year
- 2003
- Tongue
- English
- Weight
- 338 KB
- Volume
- 31
- Category
- Article
- ISSN
- 0091-2751
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✦ Synopsis
Purpose:
We compared the usefulness of levovist-enhanced power doppler imaging (pdi) and helical ct in the depiction of tumor vascularity before and after percutaneous ablation of small hepatocellular carcinomas (hccs).
Methods:
Thirty-one cirrhotic patients with solitary unresectable hccs smaller than 5 cm (mean size, 2.7 +/- 0.8 cm; range, 1.5-5.0 cm) recruited over a 15-month period were treated with percutaneous ethanol injection (n = 9) or radiofrequency ablation (n = 22). pdi, contrast-enhanced pdi (using levovist), and multiphase contrast-enhanced helical ct were performed before and after percutaneous ablation, and vascularity findings were compared.
Results:
Levovist significantly increased baseline intratumoral doppler signals on pdi compared to non-contrast pdi. the most frequent tumor vascularity pattern was heterogeneous (45%). vascularity was identified in all tumors by both contrast-enhanced pdi and helical ct before ablation. after percutaneous ablation, intratumoral vascularity was detected in 11 tumors by contrast-enhanced pdi and in 15 tumors by ct. the sensitivity, specificity, and diagnostic accuracy of contrast-enhanced pdi in demonstrating intratumoral vascularity, with ct being the gold standard, were 66%, 93%, and 81%, respectively. there was significant agreement between the 2 modalities in the depiction of tumor vascularity after ablation (kappa = 0.6, p = 0.001). however, there were 5 false negatives and 1 false positive with contrast-enhanced pdi. complete tumor necrosis was achieved in 21 patients (68%).
Conclusions:
There was a good concordance between contrast-enhanced pdi and helical ct in the depiction of hcc vascularity before and after percutaneous ablation. however, although contrast-enhanced pdi may be useful for real-time guidance of treatment, its low sensitivity makes it inadequate to accurately assess the completeness of ablation.