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Year : 2011 | Volume:  21 | Issue Number:  2


Technical note: Radiofrequency ablation of hepatocellular carcinoma with contrast-enhanced ultrasound guidance: First Indian experience

Kapoor Atul, Kapoor Aprajita, Mahajan Goldaa

Add Your Comments
1 shivanand Gamanagatti, 6/29/2011 2:27:54 AM
Dear Author,

In your case only CEUS is used for treatment response following RFA. As per current guidelines by the EASL criteria, CEUS is not gold standard imaging modality for therapeutic response assessment.. Hence, the treatment response as shown on CEUS should be correlated with either triple Phase CT or Triple Phase MRI.
2 Atul Kapoor, 7/9/2011 7:29:14 AM
Dear Dr Shivanand,
We have used CEUS to plan and monitor the procedure of RFA and see the immediate post procedural response which is analysed by the use of Contrast dynamics analysis software. The guidelines of BASEL-EASL were given in 2003 and recommend the use of triphasic CT at 4 weeks following RFA. We find that with the present technique we are more confident in determining the end point of the procedure in such patients. Moreover there are studies which have come up and show CEUS to have same accuracy as that of triple phase CT or MR even on long term follow up evaluation(1). Even the AASLD guidelines on HCC 2005(2) also show equal efficacy of CEUS, dynamic CT and MR. Hence the selection of modality in such a situation will depend upon the confidence of the operator and also the site and morphology of the HCC nodule. However the reported case highlights the usefulness of technique and the analysis software to accurate determine the degree of necrosis and tumor perfusion which is of advantage.
1. Frieser M, Kiesel J, Lindner A, Bernatik T, Haensler JM , Janka R, Hahn EG, Strobe D . Efficacy of Contrast-Enhanced US versus CT or MRI for the Therapeutic Control of Percutaneous Radiofrequency Ablation in the Case of Hepatic Malignancies. Ultraschall in Med 2011; 32(2): 148-153.
2. Bruix J, Sherman M. Management of Hepatocellular carcinoma. Hepatology 2005; 42(5): 1208-1236.