Contrast-enhanced ultrasound and computed tomography assessment of hepatocellular carcinoma after transcatheter arterial chemo-embolization: A systematic review

Background & Aims: Contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) are used to assess the response of hepatocellular carcinoma after transarterial chemoembolization. Our aim was to perform a systematic review to compare CEUS and CECT for therapeutic response assessment to transarterial chemoembolization in the treatment of hepatocellular carcinoma. Method: PubMed, Embase, and the Cochrane Library databases were searched from inception until January 1, 2016. Participants: patients with hepatocellular carcinoma. Intervention: transarterial chemoembolization and CECT vs CEUS. Results. Sixteen studies were included in the systematic review. The total number of patients was 858 and the mean patient age ranged from 42 to 73 years. The mean tumor size ranged from 1.0 cm to 4.3 cm. The sensitivity and specificity of CEUS ranged from 46% to 100% and 65% to 100%, respectively, and that of CECT ranged from 34% to 87% and 92% to 100%, respectively. The accuracy of CEUS ranged from 72.6% to 100% and that of CECT from 61% to 94%. Marked heterogeneity was present among the studies. Conclusion: CEUS is comparable with CECT for the therapeutic response assessment after transarterial chemoembolization. Abbreviations: CECT: Contrast-enhanced CT; CEUS: Contrast-enhanced Ultrasound; CT: Computed Tomography; HCC: Hepatocellular Carcinoma; MDCT: Multidetector row CT; MRI: Magnetic Resonance Imaging; mRECIST: modified Response Evaluation Criteria in Solid Tumors; NPV: Negative Predictive Value; PPV: Positive Predictive Value; QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies; RFA: Radiofrequency Ablation; TACE: Transcatheter Arterial Chemoembolization.