The Sono-Hepatic-Arteriography (Sono-HA) in the assessment of hepatocellular carcinoma in patients undergoing transcatheter arterial chemoembolization (TACE)

Introduction: Early detection and diagnosis of hepatocellular carcinoma is important because number, size and type of malignant lesions strongly influence patients' management. Aim of our study was to evaluate the sono-hepatic-arteriography (Sono-HA) in the detection of focal liver lesions in patients with hepatocellular carcinoma undergoing TACE and to assess the embolization result. Material and Methods: We evaluated 15 patients (52–79 years, mean 64 years) with histologically proven hepatocellular carcinoma undergoing TACE who subsequentially presented in our institution from February 2006 to May 2008. All patients underwent a conventional B-mode ultrasound examination using a high-end machine (Logiq 9, GE Healthcare, Milwaukee, USA) and a multifrequency transducer (2.5–4MHz) before dynamic contrast-enhanced ultrasound (CEUS) examination was carried out with contrast harmonic imaging (CHI) in true detection mode. For the sono-HA 1ml SonoVue® was injected as a bolus using the formerly placed intraarterial catheter, followed by 3ml NaCl. Biphasic enhanced computed tomography was performed using a 16-slice CT scanner (Sensation 16, Siemens, Kollimation 16×1mm, reconstruction of 5mm slices, arterial and portalvenous contrast after injection of 130ml Accupaque ®300) up to 48 hours before TACE and during follow-up. MRI was performed appositionally in 11 cases. Analyses were performed by two independent radiologists. Results: Lesions' size (of the largest lesion) ranged from 1 to 13 centimeters in their largest diameter (mean: 4.8cm). The findings of sono-hepatic-arteriography (Sono-HA) were correct in fourteen cases (93.3%). Direct impact on patients' management followed in eleven patients (73.3%). Conclusion: We could show that Sono-HA is able to diagnose new lesions. The findings of Sono-HA were correct in more than 90% of the examined patients and influenced patients' management in almost two-thirds. Furthermore, the simultaneous application of intraarterial contrast agent might improve TACE results and aid to immediately assess embolization success, which might contribute to improve patients' outcome.