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Kontrastmittelverstärkte Sonographie

Zur Therapiekontrolle von Radiofrequenzablation und transarterieller Chemoembolisation beim hepatozellulären Karzinom

Contrast-enhanced sonography

Therapy control of radiofrequency ablation and transarterial chemoembolization of hepatocellular carcinoma

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Zusammenfassung

Durch die Darstellung der dynamischen Tumorperfusion gelingt die Detektion des hepatozellulären Karzinoms mit Hilfe der kontrastmittelverstärkten Sonographie mit einer Sensitivität von bis zu >90% und einer Charakterisierung von Leberläsionen entsprechend der diagnostischen Sicherheit der kontrastmittelverstärkten Computertomographie.

Die dynamische Erfassung der Mikrovaskularisation mit der kontrastmittelverstärkten Sonographie erlaubt eine Differenzierung zwischen vaskularisierten Tumorläsionen und avaskularisierten Nekrosezonen vor, während und nach Intervention durch die transarterielle Chemoembolisation und Radiofrequenzablation. Zusätzlich können Volumendarstellungen und Bildfusion zur Therapiekontrolle nach diesen Interventionen hilfreich sein.

Abstract

Due to the imaging of dynamic perfusion, hepatocellular carcinoma can be detected with a sensitivity of >90% using contrast-enhanced sonography. The characterization of liver tumors with contrast-enhanced sonography is comparable to the diagnostic accuracy of contrast-enhanced computed tomography. The dynamic detection of microvascularization with contrast-enhanced sonography allows the differentiation between vascularized tumors and non-vascularized necrotic lesions before, during and after transarterial chemoembolization or percutaneous radiofrequency ablation. Image fusion with volume navigation can be useful in the follow-up control.

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Literatur

  1. Bargellini I, Vignali C, Cioni R et al (2010) Hepatocellular carcinoma: CT for tumor response after transarterial chemoembolization in patients exceeding Milan criteria-selection parameter for liver tranplantation. Radiology 255:289–300

    Article  PubMed  Google Scholar 

  2. Bolondi L, Correas JM, Lencioni R et al (2007) New perspectives for the use of contrast-enhanced liver ultrasound in clinical practice. Dig Liver Dis 39:187–195

    Article  PubMed  CAS  Google Scholar 

  3. Catala V, Nicolau C, Vilana R et al (2007) Characterization of focal liver lesions: comparative study of contrast-enhanced ultrasound versus spiral computed tomography. Eur Radiol 17:1066–1073

    Article  PubMed  CAS  Google Scholar 

  4. Chen MH, Wu W, Yang W et al (2007) The use of contrast-enhanced ultrasonography in the selection of patients with hepatocellular carcinoma for radio frequency ablation therapy. J Ultrasound Med 26:1055–1063

    PubMed  Google Scholar 

  5. Chen MH, Wu W, Yang W et al (2005) Application of contrast-enhanced ultrasonography in selecting indication of radiofrequency ablation among hepatocellular carcinoma patients. Zhonghua Yi Xue Za Zhi 85:3491–3494

    PubMed  Google Scholar 

  6. Clevert D-A, Horng A, Kopp R et al (2009) Imaging of endoleaks after endovascular aneurysm repair (EVAR) with contrast-enhanced ultrasound (CEUS). Radiologe 49:1033–1039

    Article  PubMed  Google Scholar 

  7. Clevert D-A, Horng A, Reiser MF (2009) Ultrasound imaging of the abdominal aorta. Radiologe 49:1024–1032

    Article  PubMed  Google Scholar 

  8. Clevert D-A, Jung EM, Stock KF et al (2009) Evaluation of malignant liver tumors: biphasic MS-CT versus quantitative contrast harmonic imaging ultrasound. Z Gastroenterol 47:1195–1202

    Article  PubMed  Google Scholar 

  9. Dorffel Y, Wermke W (2008) Neuroendocrine tumors: characterization with contrast-enhanced ultrasonography. Ultraschall Med 29:506–514

    Article  PubMed  CAS  Google Scholar 

  10. Gallotti A, D’Onofrio M, Ruzzenente A et al (2009) Contrast-enhanced ultrasonography (CEUS) immediately after percutaneous ablation of hepatocellular carcinoma. Radiol Med 114:1094–1105

    Article  PubMed  CAS  Google Scholar 

  11. Greis C (2009) Ultrasound contrast agents as markers of vascularity and microcirculation. Clin Hemorheol Microcirc 43:1–9

    PubMed  Google Scholar 

  12. Horng A, Reiser MF, Clevert D-A (2010) Modern sonography in the diagnosis of acute abdomen. Radiologe 50:214–225

    Article  PubMed  CAS  Google Scholar 

  13. Jung EM, Clevert D-A, Rupp N (2003) Contrast-enhanced ultrasound with optison in percutaneous thermoablation of liver tumors. Rofo 175:1403–1412

    PubMed  CAS  Google Scholar 

  14. Jung EM, Clevert D-A, Schreyer AG et al (2007) Evaluation of quantitative contrast harmonic imaging to assess malignancy of liver tumors: a prospective controlled two-center study. World J Gastroenterol 13:6356–6364

    Article  PubMed  CAS  Google Scholar 

  15. Jung EM, Kubale R, Jungius KP et al (2006) Vascularization of liver tumors – preliminary results with coded harmonic angio (CHA), phase inversion imaging, 3D power Doppler and contrast medium-enhanced B-flow with second generation contrast agent (optison). Clin Hemorheol Microcirc 34:483–497

    PubMed  CAS  Google Scholar 

  16. Jung EM, Ross CJ, Rennert J et al (2010) Characterization of microvascularization of liver tumor lesions with high resolution linear ultrasound and contrast enhanced ultrasound (CEUS) during surgery: first results. Clin Hemorheol Microcirc 46:89–99

    PubMed  CAS  Google Scholar 

  17. Jung EM, Schreyer AG, Schacherer D et al (2009) New real-time image fusion technique for characterization of tumor vascularisation and tumor perfusion of liver tumors with contrast-enhanced ultrasound, spiral CT or MRI: first results. Clin Hemorheol Microcirc 43:57–69

    PubMed  CAS  Google Scholar 

  18. Kim HJ, Kim TK, Kim PN et al (2006) Assessment of the therapeutic response of hepatocellular carcinoma treated with transcatheter arterial chemoembolization: comparison of contrast-enhanced sonography and 3-phase computed tomography. J Ultrasound Med 25:477–486

    PubMed  Google Scholar 

  19. Kono Y, Lucidarme O, Choi SH et al (2007) Contrast-enhanced ultrasound as a predictor of treatment efficacy within 2 weeks after transarterial chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 18:57–65

    Article  PubMed  Google Scholar 

  20. Ladam-Marcus V, Mac G, Job L et al (2009) Contrast-enhanced ultrasound and liver imaging: review of the literature. J Radiol 90:93–106; quiz 107–108

    Article  PubMed  CAS  Google Scholar 

  21. Lu MD, Yu XL, Li AH et al (2007) Comparison of contrast enhanced ultrasound and contrast enhanced CT or MRI in monitoring percutaneous thermal ablation procedure in patients with hepatocellular carcinoma: a multi-center study in China. Ultrasound Med Biol 33:1736–1749

    Article  PubMed  Google Scholar 

  22. Maruyama H, Kobayashi S, Yoshizumi H et al (2007) Application of percutaneous ultrasound-guided treatment for ultrasonically invisible hypervascular hepatocellular carcinoma using microbubble contrast agent. Clin Radiol 62:668–675

    Article  PubMed  CAS  Google Scholar 

  23. Minami Y, Kudo M, Hatanaka K et al (2010) Radiofrequency ablation guided by contrast harmonic sonography using perfluorocarbon microbubbles (sonazoid) for hepatic malignancies: an initial experience. Liver Int 30:759–764

    Article  PubMed  Google Scholar 

  24. Moschouris H, Malagari K, Kornezos I et al (2010) Unenhanced and contrast-enhanced ultrasonography during hepatic transarterial embolization and chemoembolization with drug-eluting beads. Cardiovasc Intervent Radiol 33:1215–1222

    Article  PubMed  Google Scholar 

  25. Nicolau C, Vilana R, Bianchi L, Bru C (2007) Early-stage hepatocellular carcinoma: the high accuracy of real-time contrast-enhanced ultrasonography in the assessment of response to percutaneous treatment. Eur Radiol 17(suppl 6):F80–F88

    Article  PubMed  Google Scholar 

  26. Nicolau C, Vilana R, Catala V et al (2006) Importance of evaluating all vascular phases on contrast-enhanced sonography in the differentiation of benign from malignant focal liver lesions. AJR Am J Roentgenol 186:158–167

    Article  PubMed  Google Scholar 

  27. Oldenburg A, Albrecht T (2008) Baseline and contrast-enhanced ultrasound of the liver in tumor patients. Ultraschall Med 29:488–498

    Article  PubMed  CAS  Google Scholar 

  28. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108

    Article  PubMed  Google Scholar 

  29. Piscaglia F, Lencioni R, Sagrini E et al (2010) Characterization of focal liver lesions with contrast-enhanced ultrasound. Ultrasound Med Biol 36:531–550

    Article  PubMed  Google Scholar 

  30. Ross CJ, Rennert J, Schacherer D et al (2010) Image fusion with volume navigation of contrast enhanced ultrasound (CEUS) with computed tomography (CT) or magnetic resonance imaging (MRI) for post-interventional follow-up after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinomas (HCC): Preliminary results. Clin Hemorheol Microcirc 46:101–115

    PubMed  CAS  Google Scholar 

  31. Salvaggio G, Campisi A, Lo Greco V et al (2010) Evaluation of posttreatment response of hepatocellular carcinoma: comparison of ultrasonography with second-generation ultrasound contrast agent and multidetector CT. Abdom Imaging 35:447–453

    Article  PubMed  Google Scholar 

  32. Schacherer D, Girlich C, Jung ME et al (2009) Transabdominal ultrasound with echoenhancement by contrast media in the diagnosis of hepatocellular carcinoma. Dig Dis 27:109–113

    Article  PubMed  Google Scholar 

  33. Schacherer D, Girlich C, Zorger N et al (2010) Sono-hepatic-arteriography (Sono-HA) in the assessment of hepatocellular carcinoma in patients undergoing transcatheter arterial chemoembolization (TACE). Ultraschall Med 31:270–275

    Article  PubMed  CAS  Google Scholar 

  34. Seitz K, Strobel D, Bernatik T et al (2009) Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions – prospective comparison in clinical practice: CEUS vs. CT (DEGUM Multicenter Trial). Parts of this manuscript were presented at the Ultrasound Dreiländertreffen 2008, Davos. Ultraschall Med 30:383–389

    Article  PubMed  CAS  Google Scholar 

  35. Strobel D, Seitz K, Blank W et al (2008) Contrast-enhanced ultrasound for the characterization of focal liver lesions – diagnostic accuracy in clinical practice (DEGUM Multicenter Trial). Ultraschall Med 29:499–505

    Article  PubMed  CAS  Google Scholar 

  36. Vilana R, Bianchi L, Varela M et al (2006) Is microbubble-enhanced ultrasonography sufficient for assessment of response to percutaneous treatment in patients with early hepatocellular carcinoma? Eur Radiol 16:2454–2462

    Article  PubMed  CAS  Google Scholar 

  37. Vogl TJ, Eichler K, Zangos S et al (2002) Hepatocellular carcinoma: role of imaging diagnostics in detection, intervention and follow-up. Rofo 174:1358–1368

    PubMed  CAS  Google Scholar 

  38. Weskott HP (2008) Emerging roles for contrast-enhanced ultrasound. Clin Hemorheol Microcirc 40:51–71

    PubMed  CAS  Google Scholar 

  39. Wilson SR, Burns PN (2010) Microbubble-enhanced US in body imaging: what role? Radiology 257:24–39

    Article  PubMed  Google Scholar 

  40. Xia Y, Kudo M, Minami Y et al (2008) Response evaluation of transcatheter arterial chemoembolization in hepatocellular carcinomas: the usefulness of sonazoid-enhanced harmonic sonography. Oncology 75(suppl 1):99–105

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland

    E.M. Jung, W. Uller & C. Stroszczynski

  2. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Großhadern, München, Deutschland

    D.-A. Clevert

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  1. E.M. Jung
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  2. W. Uller
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  3. C. Stroszczynski
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  4. D.-A. Clevert
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Correspondence to E.M. Jung.

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Jung, E., Uller, W., Stroszczynski, C. et al. Kontrastmittelverstärkte Sonographie. Radiologe 51, 462–468 (2011). https://doi.org/10.1007/s00117-010-2101-y

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  • DOI: https://doi.org/10.1007/s00117-010-2101-y

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