Background: Contrast-enhanced computed tomography (CECT) is considered the gold standard for assessing therapeutic response in hepatocellular carcinoma (HCC) following locoregional treatments. More recently, contrast-enhanced ultrasound (CEUS) has emerged as a promising, cost-effective alternative, although evidence supporting its use in this context remains limited. This study aimed to evaluate the diagnostic performance of CEUS compared to CECT in assessing local response of HCC nodules treated with radiofrequency ablation (RFA). Methods: We retrospectively analyzed a consecutively enrolled cohort of patients undergoing RFA for HCC at IRCCS San Matteo Hospital, Pavia, between January 2017 and January 2022. Follow-up imaging included both CEUS and CECT at predefined time points. Imaging follow-up, MRI, and/or histological results were used as the reference standard to compare CEUS and CECT. Results: A total of 55 patients (mean age 74 years, 64% male) with 79 HCC nodules were included. Complete response was observed in 57 nodules (72%), all correctly identified by CEUS, whereas 4 cases were misclassified by CECT. Among the 22 nodules (28%) with residual disease, CEUS correctly identified 15 cases, while 17 were detected by CECT; notably, CEUS identified 4 lesions missed by CECT, which identified 6 missed at CEUS. Combined, the two modalities detected 21 (96%) out of 22 residual tumors. CEUS showed a sensitivity of 68.1%, specificity of 100%, and diagnostic accuracy of 91.1%, compared to 68.0%, 98.1%, and 88.6%, respectively, for CECT, with no significant differences. Conclusions: CEUS is a reliable, non-inferior, and complementary modality to CECT for evaluating treatment response of HCC following RFA. Larger prospective studies are warranted to further define its role in clinical practice.
背景：增强计算机断层扫描（CECT）被认为是评估肝细胞癌（HCC）局部治疗后疗效反应的金标准。近年来，增强超声（CEUS）作为一种具有前景且经济有效的替代方法逐渐兴起，但支持其在此背景下应用的证据仍有限。本研究旨在评估CEUS与CECT在评估射频消融（RFA）治疗的HCC结节局部反应方面的诊断性能。方法：我们回顾性分析了2017年1月至2022年1月期间在帕维亚IRCCS圣马泰奥医院连续接受RFA治疗的HCC患者队列。随访影像学检查包括在预设时间点进行的CEUS和CECT。以影像学随访、磁共振成像和/或组织学结果为参考标准，比较CEUS与CECT的诊断效能。结果：共纳入55例患者（平均年龄74岁，男性占64%），涉及79个HCC结节。57个结节（72%）观察到完全缓解，CEUS全部正确识别，而CECT误判了4例。在22个存在残留病灶的结节（28%）中，CEUS正确识别了15例，CECT识别了17例；值得注意的是，CEUS发现了4个被CECT遗漏的病灶，而CECT则识别出6个CEUS未检出的病灶。两种方法联合检测出22个残留肿瘤中的21个（96%）。CEUS的敏感性为68.1%、特异性为100%、诊断准确率为91.1%，而CECT分别为68.0%、98.1%和88.6%，两者无显著差异。结论：CEUS是评估HCC射频消融后治疗反应的一种可靠、非劣效且与CECT互补的检查方法。需要更大规模的前瞻性研究进一步明确其在临床实践中的作用。
肿瘤(癌症)患者之家