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. 2012 Mar;24(1):44-51.
doi: 10.1007/s11670-012-0044-8.

Role of contrast enhanced ultrasound in radiofrequency ablation of metastatic liver carcinoma

Jin-Yu Wu  1 , Min-Hua Chen, Wei Yang, Shu-Zhi Lin, Wei Wu, Shan-Shan Yin, Hui Zhang, Kun Yan
Affiliations

Role of contrast enhanced ultrasound in radiofrequency ablation of metastatic liver carcinoma

Jin-Yu Wu et al. Chin J Cancer Res. 2012 Mar.

Abstract

Objective: To investigate the application of contrast enhanced ultrasound (CEUS) in planning and guiding for radiofrequency ablation (RFA) for metastatic liver carcinoma (MLC).

Methods: One hundred and thirty-five patients with clinically and pathologically diagnosed MLC (from gastrointestinal tumors) were included in the present study, and 104 of them had received CEUS prior to RFA to assess the number, size, shape, infiltration, location and enhancing features of the lesions. Among the 104 patients, 21 (20.1%) were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS. The remaining 83 patients with 147 lesions underwent RFA (group A). During the same period, other 31 patients with 102 lesions serving as control group were treated based on findings of conventional ultrasound without contrast (group B). The patients underwent follow-up enhanced CT at the 1st month, and then every 3-6 months after RFA. The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 1st month.

Results: In group A, 72 of 147 MLC lesions (48.9%) showed increased sizes on CEUS. Among them, 48 lesions (66.6%) appeared enlarged in arterial phase, and 24 (33.3%) showed enlarged hypoechoic area in parenchymal phase. CEUS showed total 61 additional lesions in 35 patients (42.1%) (ranged from 8 to 15 mm) compared with conventional ultrasound (US), and 42 (68.8%) of them were visualized in parenchymal phase only. There were total 208 lesions in group A underwent RFA with CEUS planning, and the tumor necrosis rate was 94.2% (196/208). In this group, local recurrence was found in 16 lesions (7.7%) during 3-42 months' following up, and new metastases were seen in 30 cases (36.1%). For group B, the tumor necrosis rate was 86.3% (88/102), local recurrence in 17 lesions (16.7%), and new metastases in 13 cases (41.9%). Tumor early necrosis and recurrence rates were significantly different between the two groups (P=0.018, P=0.016, respectively).

Conclusion: CEUS played an important role in RFA for liver metastases by candidate selecting and therapy planning, which helped to improve the outcome of the treatment.

Keywords: Contrast enhanced ultrasound (CEUS); Liver metastasis; Radiofrequency ablation (RFA).

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Figures

Figure 1
Figure 1
A 48-year-old female with liver metastasis for one year had surgery of colon cancer two years before. Tumor had no viability after six periods of chemotherapy. She was not candidate for RFA. A. Conventional US showed a small nodule in liver (A1) and the nodule did not enhance (↑) at artery phase (A2). B. The nodule slightly washed out at 4 min after injection. C. Biopsy pathology demonstrated fibrotic tissue and cell degeneration (HE, ×40).
Figure 2
Figure 2
A 46-year-old male with liver metastasis from colon cancer. He was not candidate for RFA. A. Conventional US showed a heterogeneous solid tumor (↑) with a size of 6 cm. B. CEUS demonstrated multiple small metastases around the main tumor and the number of tumors increased to more than 6.
Figure 3
Figure 3
A 76-year-old male with liver metastasis from rectal cancer. A. Conventional US showed a 2 cm tumor with well defined margin in Segment IV. B. CEUS showed the enhanced tumor increased to 3.8 cm in size at artery phase. C. CEUS showed the tumor washed out and represented an irregular sphere at 196 seconds after injection. D. Extended abla- tion was performed to this tumor.
Figure 4
Figure 4
A 57-year-old male with liver metastasis from rectal cancer. A. Conventional US showed a 2.1 cm tumor with well-defined margin and “bull eye” sign in Segment VI. B. CEUS showed ring-like enhancement (↑) and enhanced range increased to 2.5 cm at 36 s (B1) and to 2.6 cm (↑) in portal phase (B2) compared with conventional US. C. CEUS showed the ring enhancement washed out and the hypoechoic range reached to 3.7 cm (↑). CEUS confirmed the tumor range demonstrated by conventional US was the necrotic area of the tumor. D. Extended ablation was performed to this tumor.
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