Contrast-enhanced subtraction harmonic sonography for evaluating treatment response in patients with hepatocellular carcinoma

AJR Am J Roentgenol. 2001 Mar;176(3):661-6. doi: 10.2214/ajr.176.3.1760661.


Objective: Our objective was to assess the usefulness of contrast-enhanced subtraction harmonic sonography in evaluating the treatment response of patients with hepatocellular carcinoma.

Subjects and methods: Thirty-two hepatocellular carcinoma lesions in 26 patients (age range, 44-85 years; mean age, 66 years) were examined with Levovist-enhanced intermittent harmonic imaging before and after therapy. A Toshiba Powervision 8000 was used. A subtraction image was obtained by digitally subtracting the last-frame harmonic image from the first-frame image when multishot mode was preset. Results of contrast-enhanced CT were compared with the results of subtraction harmonic imaging.

Results: Before therapy, an enhancement pattern of tumor vascularity was seen for 93.8% (30/32) of hepatocellular carcinoma nodules on subtraction harmonic imaging. After therapy, subtraction harmonic imaging showed 46.7% (14/30) enhancement (incomplete tumor necrosis) and 53.3% (16/30) no enhancement (complete tumor necrosis). When dynamic CT was the gold standard, the sensitivity, specificity, and accuracy of subtraction harmonic imaging were 93.3%, 100%, and 96.7%, respectively. Intratumoral flow signals in hepatocellular carcinoma after therapy on harmonic imaging were used as a guide to target additional percutaneous therapy.

Conclusion: Digital subtraction contrast-enhanced harmonic imaging can depict tumor vascularity in hepatocellular carcinoma after therapy sensitively and accurately. Because it is easy to perform and provides real-time needle insertion guidance, it may be preferable to perform after localized therapy to monitor treatment response, which will reduce unnecessary CT scanning.

MeSH terms

  • Aged
  • Antibiotics, Antineoplastic / administration & dosage
  • Carcinoma, Hepatocellular / diagnostic imaging*
  • Carcinoma, Hepatocellular / therapy
  • Chemoembolization, Therapeutic
  • Contrast Media
  • Epirubicin / administration & dosage
  • Female
  • Humans
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / therapy
  • Male
  • Polysaccharides
  • Sensitivity and Specificity
  • Subtraction Technique
  • Tomography, X-Ray Computed
  • Ultrasonography


  • Antibiotics, Antineoplastic
  • Contrast Media
  • Polysaccharides
  • SHU 508
  • Epirubicin