The value of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) in predicting the short-term efficacy of conventional transarterial chemoembolization (cTACE)

BACKGROUND: This study aimed to evaluate whether corona enhancement and intratumor perfusion features of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) predict short-term tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). METHODS: This trial included 39 patients with 51 HCC target lesions who underwent cTACE with IA-CEUS. The maximum cross-sectional area ratio of intratumor perfusion between pre- and post-procedure, as well as the peak value and sickness of corona enhancement immediately post-cTACE were measured respectively. Tumor response at MRI was assessed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines. Nonparametric Spearman rank-order correlation was used to correlate the maximum cross-sectional area ratio of intratumor perfusion, the peak value, and sickness of corona enhancement of IA-CEUS immediately after cTACE with tumor response. RESULTS: The results showed that 39 patients with 51 target lesions were assessed for tumor response. Complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease (PD) were 22 (43.1%), 14 (27.5%), 10 (19.6%), and 5 (9.8%), respectively. The maximum cross-sectional area ratio of intratumor perfusion moderately correlated with tumor response on CE-MRI (Spearman rho =0.513, P<0.001). Furthermore, the peak value and sickness of corona enhancement showed a good correlation with tumor response on CE-MRI respectively (Spearman rho =0.671, P<0.001, rho =0.704, P<0.001). CONCLUSIONS: Intra-procedural transcatheter IA-CEUS may predict short-term tumor response in cTACE of HCC. The feature of corona enhancement immediately post-cTACE also showed a more accurate prediction when compared with the feature of intratumor infusion (rho =0.671).