Contrast-enhanced harmonic gray-scale sonographic-histologic correlation of the therapeutic effects of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma

OBJECTIVE. We evaluated the usefulness of contrast-enhanced harmonic wideband gray-scale sonography in the assessment of the therapeutic effects of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma and compared the performance of this imaging modality with the histologic findings for the patients. SUBJECTS AND METHODS. Twenty-nine patients with 29 hepatocellular carcinoma lesions were examined. Tumor vascularity was evaluated before and 7 days after transcatheter arterial chemoembolization with contrast-enhanced harmonic wideband gray-scale sonography performed after injection of the contrast agent Levovist. Several biopsy specimens were obtained from the evaluated lesions, and the histologic findings were compared with the results of contrast-enhanced sonography. RESULTS. Contrast-enhanced harmonic wideband gray-scale sonography performed after transcatheter arterial chemoembolization showed tumor vascularity in 16 of the 29 lesions, but none in the other 13 lesions. At histologic examination, 13 of the 16 lesions with tumor vascularity had residual tumor revealed, and the 13 lesions without tumor vascularity were found to have no histologically evident tumor residue, although three of these lesions showed tumor progression detected on CT during a 9- to 12-month follow-up period. Contrast-enhanced harmonic wideband gray-scale sonographic images were compared with the histologic findings as the gold standard, and the sensitivity and specificity of these images for discerning viable and nonviable hepatocellular carcinoma after transcatheter arterial chemoembolization were 100% and 81%, respectively. CONCLUSION. Contrast-enhanced harmonic wideband gray-scale sonography is potentially useful for evaluating the therapeutic effects of transcatheter arterial chemoembolization on hepatocellular carcinoma.