Advertisement

Abdominal Radiology

, Volume 42, Issue 5, pp 1400–1407 | Cite as

Intra-arterial contrast-enhanced ultrasound (IA CEUS) for localization of hepatocellular carcinoma (HCC) supply during transarterial chemoembolization (TACE): a case series

  • Ilya Lekht
  • Megha Nayyar
  • Brian Luu
  • Phillip L. Guichet
  • Jessica Ho
  • Ramon Ter-Oganesyan
  • Michael Katz
  • Mittul Gulati
Case Report

Abstract

Transarterial chemoembolization (TACE) is a proven catheter-based locoregional therapy for treatment of hepatocellular carcinoma (HCC). Drug-eluting bead TACE involves delivering micrometer-sized particles preloaded with doxorubicin directly to the tumor via its arterial blood supply and results in vascular embolization with intra-tumoral drug release. Effective therapy requires mapping of the tumor arterial supply, which in some cases cannot be accomplished with conventional angiographic techniques alone. Contrast-enhanced ultrasound (CEUS) is an imaging technique which utilizes microbubble contrast agents to demonstrate blood flow and tissue perfusion, enabling tumor visualization in real time. CEUS with intravenous contrast administration is well established for evaluation of HCC. Intra-arterial (IA) CEUS, on the other hand, is an emerging technique that allows more selective evaluation of the arterial supply to the tumor. The three cases in this report illustrate the utility of intra-procedural IA CEUS during TACE. Specifically, IA CEUS aided TACE in cases where the HCC showed poor arterial enhancement, an extrahepatic arterial supply, and a portal venous supply, respectively.

Keywords

Contrast-enhanced ultrasound Hepatocellular carcinoma Transarterial chemoembolization Intra-arterial contrast-enhanced ultrasound 

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.

References

  1. 1.
    Jemal A, Bray F, Center MM, et al. (2011) Global cancer statistics. CA Cancer J Clin 61:69–90CrossRefPubMedGoogle Scholar
  2. 2.
    Maluccio M, Covey A (2012) Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA Cancer J Clin 62:394–399CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Cazejust J, Bessoud B, Colignon N, et al. (2014) Hepatocellular carcinoma vascularization: from the most common to the lesser known arteries. Diagn Interv Imaging 95:27–36CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kakeda S, Korogi T, Ohnari N, et al. (2007) Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization. J Vasc Interv Radiol 18:1508–1516CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Claudon M, Dietrich CF, Choi BI, et al. (2013) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver-update 2012. A WFUMB-EFSUMB initiative in cooperation with representative of AFSUMB, AIUM, ASUM, FLAUS, and ICUS. Ultrasound Med Biol 39:187–210CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Brannigan M, Burns PN, Wilson SR (2004) Blood flow patterns in focal liver lesions at microbubble-enhanced US. Radiographics 24:921–935CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Cosgrove D, Blomley M (2004) Liver tumors: evaluation with contrast-enhanced ultrasound. Abdom Imaging 29:446–454CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    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 18:57–65CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Zorger N, Jung EM, Schreyer AG, et al. (2010) Ultrasound-arterioportography (US-AP): a new technical approach to perform detection of liver lesions. Clin Hemorheol Microcirc 46:117–126PubMedPubMedCentralGoogle Scholar
  10. 10.
    Kim HC, Chung JW, Lee W, Jae HJ, Park JH (2005) Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics 25:S25–S39CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Tohara K, Sakaguchi S, Miyajima Y, Yao T, Ono H (2001) Power Doppler sonography of hepatocellular carcinomas with portal-vein blood supply. J Clin Ultrasound 29:290–293CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Moschouris H, Malagari K, Kalokairinou M, et al. (2011) Contrast-enhanced ultrasonography with intraarterial administration of SonoVue for guidance of transarterial chemoembolization: an initial experience. Med Ultrasound 4:296–301Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ilya Lekht
    • 1
  • Megha Nayyar
    • 1
  • Brian Luu
    • 1
  • Phillip L. Guichet
    • 1
  • Jessica Ho
    • 1
  • Ramon Ter-Oganesyan
    • 1
  • Michael Katz
    • 1
  • Mittul Gulati
    • 1
  1. 1.Department of RadiologyKeck School of Medicine of the University of Southern CaliforniaLos AngelesUSA

Personalised recommendations