Role of color Doppler ultrasonography with contrast media in the monitoring of hepatocarcinoma after intralesional treatment

INTRODUCTION: We investigated the accuracy of contrast-enhanced color Doppler US in the assessment of the effectiveness of intralesional treatment of hepatocarcinomas. MATERIAL AND METHODS: Eight cirrhotic patients (HCV+), Child-Pugh class B, with a single hepatocarcinoma ( 70 years, reduced partial hepatic reserve, esophageal varices at risk, postoperative recurrence, no consent to the operation) were submitted to radiohyperthermia (6 patients) and percutaneous alcoholization (2 patients). The diagnosis was made with alpha-fetoprotein titration. CT, B-mode and color Doppler US with the administration of Levovist (Schering AG, Berlin, Germany). Thirty and 60 days after the treatment, both the alpha-fetoprotein titration and contrast-enhanced color Doppler US were repeated. RESULTS: Baseline color Doppler was carried out before intralesional treatment in the 8 patients and was followed by Levovist color Doppler which showed some intralesional signals, afferent vessels and rich vascularization in all the lesions. At the first follow-up (30 days), no intralesional vascular signals or afferent vessels were detected in any patient, while rich peripheral vascularization persisted in all cases, even after radiofrequency and alcoholization treatments. At 60 days' follow-up, the color Doppler pattern of all cases was the same as at 30 days. CONCLUSIONS: The absence of any intralesional vascular signals in all the treated patients and the possible demonstration of complete tumor necrosis seem to confirm the important role of contrast-enhanced color Doppler US in monitoring focal hepatic lesions after intralesional treatment.