What is the role of contrast-enhanced ultrasonography in the postprocedural follow-up of radiofrequency ablation (RFA) of liver tumors?

Updated: Nov 25, 2019
  • Author: Badar Bin Bilal Shafi, MBBS, MRCP, FRCR, CCT, EBIR; Chief Editor: Kurt E Roberts, MD  more...
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Studies suggest that preablation use of contrast-enhanced US (CEUS), in addition to CECT or MRI, for appropriate selection of patients improves the outcome in terms of tumor progression and efficacy of RFA therapy. [57, 58]

In images visible on US, CEUS can be valuable post RFA as compared with CECT and MRI in terms of rapidity and cost-effectiveness. This is so because CEUS can be performed immediately after the procedure without exposing the patient to radiation and because an additional treatment can be performed in the same session. [59]

CEUS has improved patient follow-up and can provide information regarding ablation similar to that obtained with CECT. [60]  A study by Brünn et al suggested that post-RFA ablation defects tend to appear smaller on CEUS than on CECT. [61]

CEUS is more useful in known ablation zones because it has a low sensitivity in identifying the safety margin and provides incomplete coverage of the liver in patients who are at high risk of developing new tumor in the other parts of the liver. [62, 22]

Fusion imaging that combines CEUS images with arterial-phase CECT or hepatobiliary-phase MRI with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (EOB-MRI) images may be useful for early evaluation of the effectiveness of RFA for small hypervascular HCC with isoechoic or unclear margins on conventional US. [63]

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