Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

Figure 2 The patient was a 59-year-old male with alcoholic liver cirrhosis. DEB-TACE and transcatheter CEUS (IAUS) using Sonazoid for HCC in S5 with a diameter of 15 mm were performed. A: Dynamic CT in the arterial phase before DEB-TACE showed a hypervascular lesion in S5 (arrow) and ascites (arrow head); B: CEUS in the arterial phase (40 s) before DEB-TACE showed a hyperenhanced lesion in S5 (arrow) (Right image: Monitor mode); C: Digital subtraction angiography (DSA) from a branch of A6 (arrow head) before DEB-TACE showed tumor enhancement (arrow). Insert image: A coaxial microcatheter was advanced in the feeding artery (arrow head); D: IAUS from the branch of A6 before DEB-TACE showed a hyperenhanced lesion (arrow). (Right image: monitor mode); E: DSA from A6 after DEB-TACE (when contrast medium disappeared from the blood vessel within 5-6 heart beats) eliminated the tumor enhancement; F: IAUS from A6 after DEB-TACE showed a residual hyperenhanced area in the tumor (arrow) in spite of elimination of tumor enhancement by DSA. Therefore, DEB-TACE for this lesion was performed repeatedly until the hyperenhanced area disappeared; G: IAUS from the right hepatic artery eliminated the residual area in the tumor (arrow); H: CEUS in the arterial phase (40 s) showed unenhancement lesion in S5 three days after DEB-TACE (arrow) (Right image: monitor mode); I: Dynamic CT in the arterial phase did not show the hypervascular lesion six months after DEB-TACE.