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Purpose <p>Accurate evaluation of tumor viability during immunotherapy for unresectable hepatocellular carcinoma (HCC) remains challenging using contrast-enhanced computed tomography or magnetic resonance imaging (CECT/CEMRI), particularly after treatment-induced vascular changes. This exploratory study investigated whether contrast-enhanced ultrasound (CEUS) detects residual intratumoral perfusion differently from CECT/CEMRI and whether CEUS perfusion patterns are associated with depth of response (DpR) in selected patients receiving immunotherapy-based combination therapy.</p> Methods <p>Twenty-five patients with unresectable HCC treated with atezolizumab plus bevacizumab, durvalumab plus tremelimumab, or nivolumab plus ipilimumab who underwent both CEUS and CECT/CEMRI within a 3-month interval were retrospectively analyzed. CEUS was performed at a median of 33&#xa0;days after treatment initiation. Arterial-phase enhancement patterns were classified as hyper-, iso-, or hypoenhancement relative to surrounding liver parenchyma. Tumor response was evaluated using RECIST version 1.1 and modified RECIST. DpR was defined as the maximum percentage reduction in tumor size from baseline.</p> Results <p>CEUS demonstrated hyperenhancement in 14 lesions compared with six lesions on CECT/CEMRI. Enhancement patterns were discordant in 13 cases, with CEUS demonstrating hyperenhancement in 10 lesions classified as iso- or hypoenhancement on CECT/CEMRI (p = 0.049). Tumor size reduction did not differ significantly among enhancement categories on CECT/CEMRI (p = 0.325), whereas CEUS enhancement patterns were significantly associated with DpR (p = 0.008).</p> Conclusion <p>In selected patients with unresectable HCC undergoing immunotherapy-based therapy, CEUS detected residual intratumoral perfusion more frequently than CECT/CEMRI and was significantly associated with DpR. CEUS may provide complementary information for exploratory assessment of tumor viability in this setting.</p>

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Contrast-enhanced ultrasound findings are associated with tumor viability and depth of response in selected patients with unresectable hepatocellular carcinoma treated with immunotherapy-based combination therapy

  • 期刊论文

  • 发表日期：

    2026年6月30日

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  • Naoki Matsumoto,
  • Masahiro Ogawa,
  • Aya Konishi,
  • Mai Totsuka,
  • Tomohiro Kaneko,
  • Masayuki Honda,
  • Shuhei Arima,
  • Yukinobu Watanabe,
  • Ryota Masuzaki,
  • Hirofumi Kogure

摘要

Purpose

Accurate evaluation of tumor viability during immunotherapy for unresectable hepatocellular carcinoma (HCC) remains challenging using contrast-enhanced computed tomography or magnetic resonance imaging (CECT/CEMRI), particularly after treatment-induced vascular changes. This exploratory study investigated whether contrast-enhanced ultrasound (CEUS) detects residual intratumoral perfusion differently from CECT/CEMRI and whether CEUS perfusion patterns are associated with depth of response (DpR) in selected patients receiving immunotherapy-based combination therapy.

Methods

Twenty-five patients with unresectable HCC treated with atezolizumab plus bevacizumab, durvalumab plus tremelimumab, or nivolumab plus ipilimumab who underwent both CEUS and CECT/CEMRI within a 3-month interval were retrospectively analyzed. CEUS was performed at a median of 33 days after treatment initiation. Arterial-phase enhancement patterns were classified as hyper-, iso-, or hypoenhancement relative to surrounding liver parenchyma. Tumor response was evaluated using RECIST version 1.1 and modified RECIST. DpR was defined as the maximum percentage reduction in tumor size from baseline.

Results

CEUS demonstrated hyperenhancement in 14 lesions compared with six lesions on CECT/CEMRI. Enhancement patterns were discordant in 13 cases, with CEUS demonstrating hyperenhancement in 10 lesions classified as iso- or hypoenhancement on CECT/CEMRI (p = 0.049). Tumor size reduction did not differ significantly among enhancement categories on CECT/CEMRI (p = 0.325), whereas CEUS enhancement patterns were significantly associated with DpR (p = 0.008).

Conclusion

In selected patients with unresectable HCC undergoing immunotherapy-based therapy, CEUS detected residual intratumoral perfusion more frequently than CECT/CEMRI and was significantly associated with DpR. CEUS may provide complementary information for exploratory assessment of tumor viability in this setting.