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July 26, 2019 — RadioGraphics


The role of contrast-enhanced US in ablative therapy for hepatocellular carcinoma includes patient selection, treatment planning, intraprocedural guidance, and immediate postprocedural assessment; the authors also describe their use of this modality for secondary surveillance.

Hepatocellular carcinoma (HCC) has a high incidence of recurrence following therapy. Therefore, secondary surveillance (scheduled follow-up imaging after treatment) is an important part of disease management. The recent approval in the United States for use of a microbubble-based contrast agent for US liver imaging promotes the increased use of contrast-enhanced US (CEUS) in patients with HCC. Although the criteria for the diagnosis of HCC at CEUS are well described, there is a paucity of published literature describing the role of CEUS in ablative therapy and secondary surveillance. In the setting of ablative therapy, CEUS can have vital roles, including patient selection, intraprocedural guidance, and immediate postprocedural assessment. Although CEUS is not widely used, the authors found that it can be used to accurately detect residual or recurrent tumor, characterize the geographic pattern of recurrence (intrazonal, extrazonal, segmental, or remote), and assess for tumor in vein. In addition, similar to primary surveillance, secondary surveillance includes assessment of the entire liver for evaluation of new nodules. Arterial phase hyperenhancement is the reference standard characteristic of disease recurrence at secondary surveillance with CEUS.

Authors: Sanjay Bansal, MD; Jonathan Gui; Christina Merrill, BSc; Jason K. Wong, MD, FRCPC; Kelly W. Burak, MD, FRCPC; Stephanie R. Wilson, MD, FRCPC

From the Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, Canada T2N 2T9 (S.B., J.G., C.M., J.K.W., S.R.W.); and Departments of Medicine, Division of Gastroenterology and Hepatol-ogy (K.W.B., S.R.W.), and Radiology (J.K.W., S.R.W.), University of Calgary, Calgary, Alberta, Canada.

*Abstract reproduced with acknowledgement and thanks to Radiological Society of North America and its RadioGraphics publication
RadioGraphics 2019; 39:0000–0000
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©RSNA, 2019

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