@article{3130229,
    title = "Contrast-enhanced ultrasonography of hepatocellular carcinoma after chemoembolisation using drug-eluting beads: A pilot study focused on sustained tumor necrosis",
    author = "Moschouris, H. and Malagari, K. and Papadaki, M.G. and Kornezos, I. and Matsaidonis, D.",
    journal = "CardioVascular and Interventional Radiology",
    year = "2010",
    volume = "33",
    number = "5",
    pages = "1022-1027",
    issn = "0174-1551, 1432-086X",
    doi = "10.1007/s00270-010-9800-7",
    keywords = "doxorubicin;  sonovue, adult;  aged;  article;  chemoembolization;  clinical article;  clinical trial;  contrast enhancement;  controlled clinical trial;  controlled study;  drug delivery system;  drug effect;  drug eluting bead;  drug response;  echography;  female;  human;  liver cell carcinoma;  male;  pilot study;  priority journal;  tumor necrosis;  tumor vascularization;  tumor volume;  vascular patency, Aged;  Carcinoma, Hepatocellular;  Chemoembolization, Therapeutic;  Doxorubicin;  Female;  Follow-Up Studies;  Humans;  Image Enhancement;  Liver;  Liver Neoplasms;  Male;  Microspheres;  Middle Aged;  Necrosis;  Neoplasm Staging;  Phospholipids;  Pilot Projects;  Sampling Studies;  Sulfur Hexafluoride;  Survival Rate;  Tomography, X-Ray Computed;  Treatment Outcome;  Ultrasonography, Interventional",
    abstract = "The purpose of this study was to assess the use of contrast-enhanced ultrasonography (CEUS) and the sustained antitumor effect of drug-eluting beads used for transarterial chemoembolisation (TACE) of unresectable hepatocellular carcinoma (HCC). Ten patients with solitary, unresectable HCC underwent CEUS before, 2 days after, and 35 to 40 days after TACE using a standard dose (4 ml) of drug-eluting beads (DC Beads; Biocompatibles, Surrey, UK) preloaded with doxorubicin (25 mg doxorubicin/ml hydrated beads). For CEUS, a second-generation contrast agent (SonoVue, Bracco, Milan, Italy) and a low mechanical-index technique were used. A part of the tumor was characterized as necrotic if it showed complete lack of enhancement. The percentage of necrosis was calculated at the sonographic section that depicted the largest diameter of the tumor. Differences in the extent of early (2 days after TACE) and delayed (35 to 40 days after TACE) necrosis were quantitatively and subjectively assessed. Early post-TACE tumor necrosis ranged from 21% to 70% (mean 43.5% ± 19%). There was a statistically significant (p = 0.0012, paired Student t test) higher percentage of delayed tumor necrosis, which ranged from 24% to 88% (mean 52.3% ± 20.3%). Subjective evaluation showed a delayed obvious increase of the necrotic areas in 5 patients. In 2 patients, tumor vessels that initially remained patent disappeared on the delayed follow-up. A part of tumor necrosis after chemoembolisation of HCC with DEB seems to take place later than 2 days after TACE. CEUS may provide evidence for the sustained antitumor effect of DEB-TACE. Nevertheless, the ideal time for the imaging evaluation of tumor response remains to be defined. © 2010 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE)."
}