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  • Title: Role of contrast-enhanced ultrasound (CEUS) in evaluation of thermal ablation zone.
    Author: Lekht I, Gulati M, Nayyar M, Katz MD, Ter-Oganesyan R, Marx M, Cen SY, Grant E.
    Journal: Abdom Radiol (NY); 2016 Aug; 41(8):1511-21. PubMed ID: 26969495.
    Abstract:
    PURPOSE: Thermal ablation has emerged as a mainstay therapy for primary and metastatic liver malignancy. Percutaneous thermal ablation is usually performed under CT and/or ultrasound guidance. CT guidance frequently utilizes iodinated contrast for tumor targeting, with additional radiation and contrast required at the end of the procedure to ensure satisfactory ablation margins. Contrast-enhanced ultrasound (CEUS) is an imaging technique utilizing microbubble contrast agents to demonstrate blood flow and tissue perfusion. In this study, we performed a retrospective review to assess the utility of CEUS in the immediate post ablation detection of residual tumor. METHODS: Sixty-four ablations were retrospectively reviewed. 6/64 ablations (9.4%) had residual tumor on the first follow-up imaging after thermal ablation. There were two groups of patients. Group 1 underwent standard protocol thermal ablation with CT and/or ultrasound guidance. Group 2 not only had thermal ablation with a protocol identical to group 1, but also had CEUS assessment at the conclusion of the procedure to ensure satisfactory ablation zone. RESULTS: The residual tumor rate in group 1 was 16.7% and the residual tumor rate in group 2 was 0%. The difference between the groups was statistically significant with a p value of 0.023. The results suggest that using CEUS assessment immediately after the ablation procedure reduces the rate of residual tumor after thermal ablation. CONCLUSION: CEUS evaluation at the end of an ablation procedure is a powerful technique providing critical information to the treating interventional radiologist, without additional nephrotoxic contrast or ionizing radiation.
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