| Objective To evaluate the clinical value of ultrasonic angiography,CT and x-ray digital subtraction angiography(DSA) in assessing the residual blood-supply and follow-up treatment of hepatic tumor after transcatheter arterial chemoembolization(TACE).Methods 30 patients with 32 hepatic tumors were examined by enhanced spiral CT,ultrasonic angiography and DSA in turn after TACE. The sensitivity,specificity and accuracy of showing residual blood-supply were compared. Treatment effects were compared in 27 focuses with varying degrees residual blood supply after TACE again.Results Enhanced CT,ultrasound angiography and DSA found no residual blood-supply in 5 focuses, the feeding arteries of these tumors were blocked completely.After a followed-up visit for 12 months, 5 focuses still remained stable. Varying degree residual blood-supply was discovered in 27 focuses. DSA showed the rich residual blood-supply in 19 focuses. Among them, ultrasonic angiography and CT also showed a large amount of residual blood-supply in 17 focuses, while the other two cases showed only a small amount of residual blood-supply. DSA showed a small amount of residual blood-supply in another 8 focuses, ultrasonic angiography showed the residual blood supply in all these tumors and enhanced CT detected only four cases. DSA as the gold standard, the sensitivity,specificity and accuracy of showing residual blood-supply of the tumors in ultrasonic angiography were total 100%,and were 85%,100%,87.5% in CT. On the other hand, after TACE treatment again, deposition of Lipiodol was good in 17 focuses with rich residual blood-supply. DSA showed feeding arteries of the tumor were not blocked and ultrasonic angiography showed artery entering in these focuses. Lipiodol also deposited well in 2 focuses which ultrasonic angiography and CT showed only partial slight strengthening in arterial phase, and DSA showed the feeding arteries were blocked but the collateral arteries opened . Lipiodol deposited not well in another 8 focuses in which DSA and ultrasonic angiography showed a small amount of residual blood-supply. DSA showed some small branches from proximal arteries or portal vein entering into the edge of focuses. Ultrasonic angiography showed slight strengthening at the edge of focuses in arterial phase or portal phase, and enhanced CT missed 4 cases. 3 cases of this group accepted TACE treatment again followed up for 3 to 50 days, Lipiodol deposition increased, but tumor blood- supply not completely blocked.1 case accepted ethanol injection and 4 accepted conformal radiotherapy with stable condition for 3 to 15 months.Conclusions 1,Ultrasonic angiography without motion artifact is less affected by the tumor size,location and Lipiodol deposition. It can show small blood vessels and low-speed flow signals. It is more sensitive and accurate than CT on showing residual blood supply of the tumor after TACE treatment, similar to DSA. 2,Ultrasonic angiography can show continuous image of the enhancement process. It makes it possible to judge the volume and source of residual blood-supply according to strengthening mode of the focuses and guide follow-up treatment after TACE. Compared with DSA, it is more easy, safe, economic and noninvasive. 3,Limitation of ultrasonic angiography is only one focus can be observed in each angiography. And it can not show the collateral artery sensitively and directly as DSA.According to reports, microbubbles can carry drugs and also serve as a gene expression and therapy vector for cancer treatment. Ultrasonic angiography can not only show the residual blood-supply and guide the follow-up treatment in hepatic tumor after TACE, but be expected to be a new method of treatment on tumor.
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