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Vascular and Interventional Radiology

E2249. Contrast-Enhanced Ultrasound in Hepatic Interventional Oncology: Emerging Applications

Gulati M,  Luu B,  Chen F,  Lekht I. Keck School of Medicine of University of Southern California, Los Angeles, CA

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Background Information: Participants will learn contrast-enhanced ultrasound (CEUS) diagnostic applications in liver imaging and its background, the use of IV CEUS in monitoring percutaneous ablations in the liver, and the use of intraarterial CEUS in hepatic transarterial chemoembolization (TACE) procedures.

Educational Goals/Teaching Points: We present Both IV and intraarterial CEUS technique; CEUS advantages, including lack of radiation and nephrotoxicity; IV CEUS in monitoring percutaneous liver ablations (CEUS appearance hepatocellular carcinoma [HCC] and metastases pre- and posttreatment, CEUS in evaluation posttreatment ablation zone with CT comparison, option of immediate additional ablation based on CEUS, postablation CEUS artifacts, and periablation hyperemia, gas, and pseudoenhancement); intraarterial CEUS in hepatic TACE procedures; localization HCC present on CT or MRI, but not seen on digital subtraction angiography (DSA), including HCC with poor DSA enhancement, HCC with extrahepatic arterial supply, intraarterial CEUS in mapping tumor supply, and HCC with portal venous supply.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Participant will be familiar with technique, advantages, and limitations of CEUS in liver interventions; And understand the role of IV CEUS in monitoring percutaneous liver ablations, and of intraarterial CEUS in localizing liver lesions during TACE.

Conclusion: CEUS is an emerging technique with protean applications in hepatic interventional oncology.