Unenhanced and Contrast-Enhanced Ultrasonography During Hepatic Transarterial Embolization and Chemoembolization With Drug-Eluting Beads

The purpose of this study was to describe and evaluate the findings of unenhanced ultrasonography (US) and contrast-enhanced ultrasonography (CEUS) when these modalities are applied during transarterial embolization (TAE) en transarterial chemoembolization (TACE) of liver tumors Sixteen tumors (9 hepatocellular carcinomas, 5 metastases from colorectal cancer, and 2 hemangiomas) were treated with TAE with microspheres and/or TACE with drug-eluting beads All of these lesions were studied with Intraprocedural unenhanced US and 12 were studied with Intraprocedural CEUS For the latter, a second-generation echo-enhancer (SonoVue, Bracco Milan Italy) and a low, mechanical index technique were used Intraprocedural findings were classified according to an arbitrary scale and were compared with pretreatment imaging (CEUS and computed tomography or CEUS and magnetic resonance imaging), with postembolization angiography, and with follow-up results On unenhanced intraprocedural US 13 of 16 tumors demonstrated intralesional high-le vel echoes of varying extent These feature correlated poorly (r = 0 33, p = 0 097) with and generally underestimated the actual extent of necrosis Exceptionally high-level echoes that occupied the largest part of the treated lesions were associated with >50% tumor necrosis Intraprocedural CEUS clearly depicted immediate partial or complete disappearance of tumor enhancement as a result of TAE/TACE Three of 6 tumors with complete devascularization on postembolization angiogram showed residual enhancement on intraprocedural CEUS Intraprocedural CEUS findings correlated closely (r = 0 91, p = 0 002) with follow-up findings Intraprocedural sonography particularly with echo-enhancers, could be used for intraprocedural monitoring in selected cases of liver tumors that undergo TAE or TACE.