Dynamic Contrast-Enhanced Ultrasound (DCE-US) for Easy and Rapid Evaluation of Hepatocellular Carcinoma Compared to Dynamic Contrast-Enhanced Computed Tomography (DCE-CT) – A Pilot Study

 

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Abstract

Purpose: To check the feasibility of the easy quantification of tumor vascularization derived from dynamic contrast-enhanced ultrasound (DCE-US) in comparison to dynamic contrast-enhanced computed tomography (DCE-CT) in patients with hepatocellular carcinoma (HCC).

Materials and Methods: 19 patients with cirrhosis and histologically proven HCC prospectively underwent CEUS (SonoVue) and CT (Imeron400). Following CEUS, the software ImageJ was used for the easy quantification of the echogenicity in HCC lesions and tumor-free liver parenchyma. For DCE-CT we used the software Hepacare and created arterial enhancement fraction color maps of the whole liver and HCC lesions.

Results: Unifocal/multifocal HCCs were detected in 12/7 (US) and 10/9 patients (CT) and biopsied nodules were defined as a reference lesion with a median of 40 mm (US) and 42 mm (CT). CEUS showed HCC-typical hyper-/hypoenhancement in the arterial/late phase in 16/19 reference lesions, while all reference lesions showed an HCC-typical vascular pattern in CT. With DCE-US, quantitative assessment could not be performed in 3/19 patients due to respiratory motion or insufficient image quality. 13/16 reference lesions showed an HCC-typical vascular pattern. Quantitative assessment was possible with DCE-CT in all patients and all reference nodules showed HCC-typical values of the arterial enhancement fraction. There was no statistical difference between CEUS, DCE-US and DCE-CT in the quantitative assessment of contrast enhancement.

Conclusion: The quantitative evaluation of DCE-US was feasible in HCC without a statistical difference with respect to DCE-CT. Further studies with a larger study population including small nodules ≤ 2 cm are needed to assess whether this technique is helpful in routine ultrasound.

Zusammenfassung

Ziel: Vergleich der Durchführbarkeit einer einfachen Quantifizierung der Vaskularisation von hepatozellulärem Karzinom (HCC) mittels dynamisch kontrastmittelverstärktem Ultraschall (DCE-US) versus dynamisch kontrastmittelverstärkter Computertomografie (DCE-CT).

Material und Methoden: 19 Patienten mit Leberzirrhose und histologisch bestätigtem HCC wurden mit CEUS und CT untersucht. Im Anschluss an CEUS wurde mittels der Software ImageJ die Echogenität von HCC-Läsionen sowie Leberparenchym errechnet. Für DCE-CT wurden mittels der Software Hepacare AEF-Farbtafeln für die gesamte Leber und HCC-Herde erstellt.

Ergebnisse: Unifokale/multifokale HCCs zeigten sich bei 12/7 (US) und 10/9 Patienten (CT). Es wurde bei mehreren Läsionen der biopsierte Herd als Referenzläsion mit einem Median von 40 mm (US) und 42 mm (CT) bestimmt. Mittels CEUS zeigten 16/19 Referenzläsionen HCC-typische Hyper-/Hypovaskularisierung in der arteriellen/Spätphase, während alle Referenzläsionen in der CT ein HCC-typisches Vaskularisationsmuster zeigten. Bei 3/19 der Patienten konnte durch Atembewegungen oder unzureichende Bildqualität kein DCE-US erhoben werden; bei 13/16 Patienten konnten HCC-typische Vaskularisationsbefunde erhoben werden. In der DCE-CT zeigten sich bei allen Referenzläsionen HCC-typische AEF-Werte. Es bestand kein statistisch signifikanter Unterschied zwischen den Ergebnissen von CEUS, DCE-US und DCE-CT.

Schlussfolgerung: Mittels DCE-US war die Erhebung quantitativer Daten in der Mehrzahl der Patienten ohne statistischen Unterschied zur DCE-CT möglich. Studien mit größeren Fallzahlen inklusive Läsionen ≤ 2 cm sind erforderlich, um den Nutzen dieser einfach durchführbaren Methode im klinischen Alltag zu überprüfen.

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