Evaluation of treatment response after chemoembolisation (TACE) in hepatocellular carcinoma using real time image fusion of contrast-enhanced ultrasound (CEUS) and computed tomography (CT) - Preliminary results
Issue title: Selected Presentations of the 32nd Annual Conference of the German Society for Clinical Hemorheology and Microcirculation
Affiliations: Department of Internal Medicine I, University of Regensburg, Regensburg, Germany | Institute for Radiology, University of Regensburg, Regensburg, Germany | Department of Internal Medicine, University of Bern, Bern, Switzerland
Note: [] Corresponding author: Hella Wobser, MD, Department of Internal Medicine I, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. Tel.: +49 941 944 7010; Fax: +49 941 944 7073; E-mail: hella.wobser@klinik.uni-regensburg.de
Abstract: OBJECTIVE: To evaluate treatment response of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) with a new real-time imaging fusion technique of contrast-enhanced ultrasound (CEUS) with multi-slice detection computed tomography (CT) in comparison to conventional post-interventional follow-up. MATERIAL AND METHODS: 40 patients with HCC (26 male, ages 46–81 years) were evaluated 24 hours after TACE using CEUS with ultrasound volume navigation and image fusion with CT compared to non-enhanced CT and follow-up contrast-enhanced CT after 6–8 weeks. Reduction of tumor vascularization to less than 25% was regarded as “successful” treatment, whereas reduction to levels >25% was considered as “partial” treatment response. Homogenous lipiodol retention was regarded as successful treatment in non-enhanced CT. RESULTS: Post-interventional image fusion of CEUS with CT was feasible in all 40 patients. In 24 patients (24/40), post-interventional image fusion with CEUS revealed residual tumor vascularity, that was confirmed by contrast-enhanced CT 6–8 weeks later in 24/24 patients. In 16 patients (16/40), post-interventional image fusion with CEUS demonstrated successful treatment, but follow-up CT detected residual viable tumor (6/16). Non-enhanced CT did not identify any case of treatment failure. Image fusion with CEUS assessed treatment efficacy with a specificity of 100%, sensitivity of 80% and a positive predictive value of 1 (negative predictive value 0.63). CONCLUSIONS: Image fusion of CEUS with CT allows a reliable, highly specific post-interventional evaluation of embolization response with good sensitivity without any further radiation exposure. It can detect residual viable tumor at early state, resulting in a close patient monitoring or re-therapy.
