Contrast-enhanced ultrasound (CEUS) may have a role in detecting residual liver cancer, suggest findings published December 16 in Radiology.
Researchers led by Lianhua Zhu, MD, from the Chinese PLA General Hospital in Beijing, found that CEUS with consensus interpretation achieved a performance that was noninferior to contrast-enhanced MRI with one reader in finding residual viable hepatocellular carcinoma (HCC).
“This study highlights CEUS as a valuable complementary imaging modality to contrast-enhanced MRI for assessing treatment response and guiding clinical decision-making,” Zhu and co-authors wrote.
For patients with unresectable HCC, it is important to accurately assess residual viable HCC after downstaging therapy for clinical decision-making.
Emerging research suggests that CEUS has advantages over MRI and can monitor treatment response after local-regional therapies. Research also highlights that CEUS can evaluate tumor biologic characteristics and therapeutic efficacy during systemic antiangiogenic and immunotherapy regimens.
Images depict a 49-year-old male participant with hepatocellular carcinoma following downstaging therapy. (A) Transverse dual contrast-enhanced ultrasound (CEUS) image (left) and B-mode image (right) show the tumor lesion. (B) Image shows an axial contrast-enhanced MRI scan of the tumor lesion. Both CEUS and contrast-enhanced MRI reveal no evidence of residual viable tumor (arrow). Histopathologic analysis further confirmed the absence of residual viable tumor.RSNA
Zhu and colleagues evaluated CEUS’ diagnostic performance for finding residual viable tumors in HCC patients who underwent lenvatinib and antiprogrammed cell death protein-1 (PD-1) antibody therapy. The team compared results with those of contrast-enhanced MRI.
The prospective study included 67 participants with a median age of 56 years. The participants had a total of 95 HCC lesions.
The researchers reported the following:
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CEUS and contrast-enhanced MRI showed good agreement in finding residual viable tumors (reader 1, κ = 0.78; reader 2, κ = 0.73).
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Compared with contrast-enhanced MRI, CEUS achieved noninferior sensitivity (89% vs. 84%; p < 0.001) and area under the receiver operating characteristic curve (AUC 0.85 versus 0.84; p = 0.02).
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CEUS had lower specificity than that of MRI (81% vs. 84%), not meeting the noninferiority margin (p = 0.24).
On subgroup analysis based on pathologic findings (21 viable and 15 nonviable tumors), CEUS had similar sensitivity (difference, 9%; p = 0.24), specificity (difference, −7%; p = 0.75), and AUC (difference, 0.01; p = 0.91) when compared with contrast-enhanced MRI.
The study authors highlighted some benefits that CEUS has over contrast-enhanced MRI. These include the microbubbles in CEUS leading to real-time visualization of arterial enhancement with high temporal resolution, faster exam times, and allowance of repeated contrast material administration.
“The high concordance between CEUS and contrast-enhanced MRI supports its role as a pragmatic adjunct, particularly for patients requiring serial perfusion assessments or those with contraindications to contrast-enhanced MRI,” the authors wrote.
The team also called for future studies to include non-CEUS-visible lesions for imaging comparisons. It also wrote that larger histopathology-based studies can assess CEUS diagnostic performance, while prospective multicenter trials with longer follow-ups could validate tumor thresholds from CEUS.
Read the full study here.