Hepatocellular carcinoma treatment with percutaneous ethanol injection: Evaluation with contrast-enhanced color Doppler US

PURPOSE: To investigate the ability of contrast agent-enhanced color Doppler ultrasonography (US) in evaluating the response of hepatocellular carcinoma (HCC) to percutaneous ethanol injection (PEI). MATERIALS AND METHODS: Forty-two patients (36 men, six women; age range, 51-79 years) with 54 1.3-7.0-cm-diameter (mean +/- SD, 2.8 cm +/- 1.1) HCC lesions were examined with contrast-enhanced color,Doppler US before and after PEI. Spiral computed tomography (CT) and percutaneous biopsy also were performed to establish the outcome of therapy. RESULTS: Before PEI, intratumoral color signals were demonstrated at contrast-enhanced color Doppler US in 47 (87%) lesions (in 40 patients). After PEI, blood flow signals were no longer detected in all 34 of the lesions that were found to be necrotic at spiral CT and biopsy. In 12 (92%) of 13 lesions containing residual viable tumor, intratumoral color signals corresponding to the enhancing areas at spiral CT were still identified at contrast-enhanced color Doppler US. These 12 lesions were retreated with PEI by targeting the areas of residual tumor with contrast-enhanced color Doppler US guidance. Complete necrosis was seen after the second PEI cycle in nine of 12 lesions. CONCLUSION: Contrast-enhanced color Doppler US shows promise in assessing the therapeutic effect of PEI on HCC and in guiding additional treatment in cases of incomplete response.