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Article 12, 4/2016

SYSTEMATIC REVIEW

Contrast-Enhanced Ultrasound and Computed Tomography Assessment of Hepatocellular Carcinoma after Transcatheter Arterial Chemo-Embolization: A Systematic Review

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Cheng-Jeng Tai1,2, Ming-Te Huang3, Chih-Hsiung Wu4, Chen-Jei Tai5,6, Yeu-Ching Shi7, Chun-Chao Chang8, Yu-Jia Chang9,10, Li-Jen Kuo3,9,10, Po-Lei Wei3,9,10, Ray-Jade Chen3,9, Hung-Yi Chiou11

1) Division of Hematology and Oncology, Department of Internal Medicine;
2) School of Medicine, College of Medicine;
3) Department of Surgery, School of Medicine, College of Medicine, Taipei, Taiwan;
4) Department of Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan;
5) Department of Chinese Medicine;
6) Traditional Herbal Medicine Research Center;
7) Taiwan Indigena Botanica Co., Ltd., Taipei, Taiwan;
8) Division of Gastroenterology, Department of Internal Medicine;
9) Division of General Surgery, Department of Surgery, Taipei Medical University Hospital; Taipei, Taiwan;
10) Graduate Institute of Clinical Medicine, College of Medicine;
11) School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.254.tai

ABSTRACT
Background & Aims: Contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) are used to assess the response of hepatocellular carcinoma after transarterial chemoembolization. Our aim was to perform a systematic review to compare CEUS and CECT for therapeutic response assessment to transarterial chemoembolization in the treatment of hepatocellular carcinoma.

Method: PubMed, Embase, and the Cochrane Library databases were searched from inception until January 1, 2016. Participants: patients with hepatocellular carcinoma. Intervention: transarterial chemoembolization and CECT vs CEUS.

Results. Sixteen studies were included in the systematic review. The total number of patients was 858 and the mean patient age ranged from 42 to 73 years. The mean tumor size ranged from 1.0 cm to 4.3 cm. The sensitivity and specificity of CEUS ranged from 46% to 100% and 65% to 100%, respectively, and that of CECT ranged from 34% to 87% and 92% to 100%, respectively. The accuracy of CEUS ranged from 72.6% to 100% and that of CECT from 61% to 94%. Marked heterogeneity was present among the studies.

Conclusion: CEUS is comparable with CECT for the therapeutic response assessment after transarterial chemoembolization.

Key words: hepatocellular carcinoma – transarterial chemoembolization – contrast-enhanced ultrasound – contrast enhanced CT.

Abbreviations: CECT: Contrast-enhanced CT; CEUS: Contrast-enhanced Ultrasound; CT: Computed Tomography; HCC: Hepatocellular Carcinoma; MDCT: Multidetector row CT; MRI: Magnetic Resonance Imaging; mRECIST: modified Response Evaluation Criteria in Solid Tumors; NPV: Negative Predictive Value; PPV: Positive Predictive Value; QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies; RFA: Radiofrequency Ablation; TACE: Transcatheter Arterial Chemoembolization.