Quantitative dynamic contrast-enhanced ultrasound to predict intrahepatic recurrence of hepatocellular carcinoma after radiofrequency ablation: a cohort study

Abstract

Purpose: Quantitative dynamic contrast-enhanced ultrasonography (CEUS) reflects tumor blood perfusion. There are very few studies on the relationship between intrahepatic recurrence of hepatocellular carcinoma (HCC) and tumor perfusion. We investigated the correlation of dynamic CEUS parameters with intrahepatic recurrence after radiofrequency ablation (RFA). Methods: This retrospective study enrolled 125 native HCC patients who underwent RFA between September 2017 and January 2019 with curative intent. Pre-ablation quantitative dynamic CEUS was performed. CEUS parameters were extracted from time–intensity curves. The correlation of CEUS parameters with intrahepatic recurrence was investigated. Results: The mean follow-up time was 21.6 ± 7.9 months. The recurrence rate was 33.6%. Univariate and multivariate analyses revealed that tumor peak intensity (PI) was a significant independent risk factor for intrahepatic recurrence after RFA (hazard ratio (HR), 0.3; 95% CI, 0.1–0.9). A PI of 58.8% (area under curve, 0.72; 95% CI, 0.63–0.81) was considered as the optimal cutoff level to predict the intrahepatic recurrence of HCC in patients after RFA. The recurrence-free survival rate in patients with a PI > 58.8% was 94.4% at 1 year and 77.8% at 2 years. Subgroup analysis showed that the HR of time to peak (TTP) in intrahepatic recurrence was 1.1417 (95% CI, 0.9748–1.1436; p = 0.1973) in the patient group with tumor diameter > 31 mm. Conclusion: CEUS is commonly used in HCC patients who undergo RFA. The CEUS parameters PI and TTP are associated with intrahepatic recurrence after RFA, and can thus be used to identify patients at risk for intrahepatic recurrence.