Korean J Radiol.  2019 Jul;20(7):1114-1123. 10.3348/kjr.2018.0932.

Microvascular Flow Imaging of Residual or Recurrent Hepatocellular Carcinoma after Transarterial Chemoembolization: Comparison with Color/Power Doppler Imaging

Affiliations
  • 1Department of Radiology, Seoul National University Hospital, Seoul, Korea. jmsh@snu.ac.kr
  • 2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 4Samsung Medison Co., Ltd., Seoul, Korea.
  • 5Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

Abstract


OBJECTIVE
To determine the feasibility of microvascular flow imaging (MVFI) in comparison with color/power Doppler imaging (CDI/PDI) for detection of intratumoral vascularity in suspected post-transarterial chemoembolization (TACE) residual or recurrent hepatocellular carcinomas (HCCs) by using contrast-enhanced ultrasonography (CEUS) or hepatic angiography (HA) findings as the reference standard.
MATERIALS AND METHODS
One hundred HCCs (mean size, 2.2 cm) in 100 patients treated with TACE were included in this prospective study. CDI, PDI, and MVFI were performed in tandem for evaluating intratumoral vascularity of the lesions by using an RS85 ultrasound scanner (Samsung Medison Co., Ltd.). Intratumoral vascularity in each technique was assessed by two radiologists in consensus by using a 5-point scale. Then, one of the two radiologists and another radiologist performed additional image review in the reverse order (MVFI-PDI-CDI) for evaluation of intra- and interobserver agreements. Results were then compared with those of either HA or CEUS as the reference. The McNemar test, logistic regression analysis, and intraclass correlation coefficient (ICC) were used.
RESULTS
CEUS or HA revealed intratumoral vascularity in 87% (87/100) of the tumors. Sensitivity (79.3%, 69/87) and accuracy (80.0%, 80/100) of MVFI were significantly higher than those of CDI (sensitivity, 27.6% [24/87]; accuracy, 37.0% [37/100]) or PDI (sensitivity, 36.8% [32/87]; accuracy, 44.0% [44/100]) (all p < 0.05). CDI, PDI, and MVFI presented excellent intraobserver (ICCs > 0.9) and good interobserver agreements (ICCs > 0.6).
CONCLUSION
MVFI demonstrated significantly higher sensitivity and accuracy than did CDI and PDI for the detection of intratumoral vascularity in suspected residual or recurrent HCCs after TACE.

Keyword

Hepatocellular carcinoma; Transarterial chemoembolization; Microvascular flow imaging; Doppler imaging; Blood flow
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