Contrast-enhanced ultrasound in planning thermal ablation of liver metastases

Should the hypervascular halo be included in the ablation volume?

A. Andreano, E. Meneghel, G. Bovo, D. Ippolito, A. Salvioni, C. Filice, S. Sironi, M. F. Meloni

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: Liver metastases often exhibit a hypervascular halo during the arterial phase of contrast-enhanced ultrasonography (CEUS). This finding has no correlates on baseline gray-scale imaging, and it has never been characterized. The aim of this study was to identify the features of this halo and determine whether it should be included in the ablation volume during thermal ablation procedures. Materials and methods: We prospectively enrolled 25 patients referred to our department for thermal ablation of liver metastases. Before treatment all patients underwent CEUS, and the maximum diameter of the metastatic lesion was measured before administration of the ultrasound contrast agent and during the arterial and portal venous phases of the contrast contrast-enhanced study. Maximum diameters in the different vascular phases were compared with the Turkey-Kramer test. Two biopsies were obtained from each lesion with a 21-gauge needle: 1) one from the center of the metastasis to confirm the diagnosis and 2) one from the hypervascular peripheral halo identified in the arterial phase at CEUS. Results: The mean (±standard deviation) maximum lesion diameter was 2.67 ± 1.2 cm before contrast agent injection, 3.50 ± 1.4 cm during the arterial phase, and 2.71 ± 1.2 cm during the venous phase. The difference between maximum diameters measured before contrast enhancement and in the arterial phase was highly significant (mean: 0.84 ± 0.45 cm, p <0.0001). Histological examination of halo specimens revealed inflammatory infiltrates with no evidence of tumor infiltration in 24/25 (96%) cases and normal hepatic parenchymal tissue in the 25th specimen. Discussion: The hypervascular halo surrounding liver metastases during the arterial phase of CEUS represents a chronic inflammatory infiltrate, not tumor infiltration. However, since chronic inflammation appears to promote neovascularization and the production of tumoral growth factors, it seems wise to include the hypervascular halo in the intended-to-treat volume when planning the ablation procedure.

Original languageEnglish
Pages (from-to)158-163
Number of pages6
JournalJournal of Ultrasound
Volume13
Issue number4
DOIs
Publication statusPublished - Dec 2010

Fingerprint

Ultrasonography
Hot Temperature
Neoplasm Metastasis
Liver
Contrast Media
Turkey
Needles
Blood Vessels
Neoplasms
Intercellular Signaling Peptides and Proteins
Inflammation
Biopsy
Injections
Therapeutics

Keywords

  • Contrast-enhanced ultrasound
  • Hypervascular halo
  • Liver metastasis
  • Thermal ablation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Internal Medicine

Cite this

Contrast-enhanced ultrasound in planning thermal ablation of liver metastases : Should the hypervascular halo be included in the ablation volume? / Andreano, A.; Meneghel, E.; Bovo, G.; Ippolito, D.; Salvioni, A.; Filice, C.; Sironi, S.; Meloni, M. F.

In: Journal of Ultrasound, Vol. 13, No. 4, 12.2010, p. 158-163.

Research output: Contribution to journalArticle

@article{5995de04d5df4115932b373619597083,
title = "Contrast-enhanced ultrasound in planning thermal ablation of liver metastases: Should the hypervascular halo be included in the ablation volume?",
abstract = "Introduction: Liver metastases often exhibit a hypervascular halo during the arterial phase of contrast-enhanced ultrasonography (CEUS). This finding has no correlates on baseline gray-scale imaging, and it has never been characterized. The aim of this study was to identify the features of this halo and determine whether it should be included in the ablation volume during thermal ablation procedures. Materials and methods: We prospectively enrolled 25 patients referred to our department for thermal ablation of liver metastases. Before treatment all patients underwent CEUS, and the maximum diameter of the metastatic lesion was measured before administration of the ultrasound contrast agent and during the arterial and portal venous phases of the contrast contrast-enhanced study. Maximum diameters in the different vascular phases were compared with the Turkey-Kramer test. Two biopsies were obtained from each lesion with a 21-gauge needle: 1) one from the center of the metastasis to confirm the diagnosis and 2) one from the hypervascular peripheral halo identified in the arterial phase at CEUS. Results: The mean (±standard deviation) maximum lesion diameter was 2.67 ± 1.2 cm before contrast agent injection, 3.50 ± 1.4 cm during the arterial phase, and 2.71 ± 1.2 cm during the venous phase. The difference between maximum diameters measured before contrast enhancement and in the arterial phase was highly significant (mean: 0.84 ± 0.45 cm, p <0.0001). Histological examination of halo specimens revealed inflammatory infiltrates with no evidence of tumor infiltration in 24/25 (96{\%}) cases and normal hepatic parenchymal tissue in the 25th specimen. Discussion: The hypervascular halo surrounding liver metastases during the arterial phase of CEUS represents a chronic inflammatory infiltrate, not tumor infiltration. However, since chronic inflammation appears to promote neovascularization and the production of tumoral growth factors, it seems wise to include the hypervascular halo in the intended-to-treat volume when planning the ablation procedure.",
keywords = "Contrast-enhanced ultrasound, Hypervascular halo, Liver metastasis, Thermal ablation",
author = "A. Andreano and E. Meneghel and G. Bovo and D. Ippolito and A. Salvioni and C. Filice and S. Sironi and Meloni, {M. F.}",
year = "2010",
month = "12",
doi = "10.1016/j.jus.2010.10.009",
language = "English",
volume = "13",
pages = "158--163",
journal = "Journal of Ultrasound",
issn = "1971-3495",
publisher = "Elsevier Masson SAS",
number = "4",

}

TY - JOUR

T1 - Contrast-enhanced ultrasound in planning thermal ablation of liver metastases

T2 - Should the hypervascular halo be included in the ablation volume?

AU - Andreano, A.

AU - Meneghel, E.

AU - Bovo, G.

AU - Ippolito, D.

AU - Salvioni, A.

AU - Filice, C.

AU - Sironi, S.

AU - Meloni, M. F.

PY - 2010/12

Y1 - 2010/12

N2 - Introduction: Liver metastases often exhibit a hypervascular halo during the arterial phase of contrast-enhanced ultrasonography (CEUS). This finding has no correlates on baseline gray-scale imaging, and it has never been characterized. The aim of this study was to identify the features of this halo and determine whether it should be included in the ablation volume during thermal ablation procedures. Materials and methods: We prospectively enrolled 25 patients referred to our department for thermal ablation of liver metastases. Before treatment all patients underwent CEUS, and the maximum diameter of the metastatic lesion was measured before administration of the ultrasound contrast agent and during the arterial and portal venous phases of the contrast contrast-enhanced study. Maximum diameters in the different vascular phases were compared with the Turkey-Kramer test. Two biopsies were obtained from each lesion with a 21-gauge needle: 1) one from the center of the metastasis to confirm the diagnosis and 2) one from the hypervascular peripheral halo identified in the arterial phase at CEUS. Results: The mean (±standard deviation) maximum lesion diameter was 2.67 ± 1.2 cm before contrast agent injection, 3.50 ± 1.4 cm during the arterial phase, and 2.71 ± 1.2 cm during the venous phase. The difference between maximum diameters measured before contrast enhancement and in the arterial phase was highly significant (mean: 0.84 ± 0.45 cm, p <0.0001). Histological examination of halo specimens revealed inflammatory infiltrates with no evidence of tumor infiltration in 24/25 (96%) cases and normal hepatic parenchymal tissue in the 25th specimen. Discussion: The hypervascular halo surrounding liver metastases during the arterial phase of CEUS represents a chronic inflammatory infiltrate, not tumor infiltration. However, since chronic inflammation appears to promote neovascularization and the production of tumoral growth factors, it seems wise to include the hypervascular halo in the intended-to-treat volume when planning the ablation procedure.

AB - Introduction: Liver metastases often exhibit a hypervascular halo during the arterial phase of contrast-enhanced ultrasonography (CEUS). This finding has no correlates on baseline gray-scale imaging, and it has never been characterized. The aim of this study was to identify the features of this halo and determine whether it should be included in the ablation volume during thermal ablation procedures. Materials and methods: We prospectively enrolled 25 patients referred to our department for thermal ablation of liver metastases. Before treatment all patients underwent CEUS, and the maximum diameter of the metastatic lesion was measured before administration of the ultrasound contrast agent and during the arterial and portal venous phases of the contrast contrast-enhanced study. Maximum diameters in the different vascular phases were compared with the Turkey-Kramer test. Two biopsies were obtained from each lesion with a 21-gauge needle: 1) one from the center of the metastasis to confirm the diagnosis and 2) one from the hypervascular peripheral halo identified in the arterial phase at CEUS. Results: The mean (±standard deviation) maximum lesion diameter was 2.67 ± 1.2 cm before contrast agent injection, 3.50 ± 1.4 cm during the arterial phase, and 2.71 ± 1.2 cm during the venous phase. The difference between maximum diameters measured before contrast enhancement and in the arterial phase was highly significant (mean: 0.84 ± 0.45 cm, p <0.0001). Histological examination of halo specimens revealed inflammatory infiltrates with no evidence of tumor infiltration in 24/25 (96%) cases and normal hepatic parenchymal tissue in the 25th specimen. Discussion: The hypervascular halo surrounding liver metastases during the arterial phase of CEUS represents a chronic inflammatory infiltrate, not tumor infiltration. However, since chronic inflammation appears to promote neovascularization and the production of tumoral growth factors, it seems wise to include the hypervascular halo in the intended-to-treat volume when planning the ablation procedure.

KW - Contrast-enhanced ultrasound

KW - Hypervascular halo

KW - Liver metastasis

KW - Thermal ablation

UR - http://www.scopus.com/inward/record.url?scp=78649867976&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649867976&partnerID=8YFLogxK

U2 - 10.1016/j.jus.2010.10.009

DO - 10.1016/j.jus.2010.10.009

M3 - Article

VL - 13

SP - 158

EP - 163

JO - Journal of Ultrasound

JF - Journal of Ultrasound

SN - 1971-3495

IS - 4

ER -