Contrast-enhanced ultrasound for assessing blood flow modulation of hepatocellular carcinoma by hydralazine

Modulating aberrant tumor microvasculature provides unique opportunities for enhancing ultrasound imaging of hepatocellular carcinoma (HCC). This study aims to use contrast-enhanced ultrasound to evaluate the potential of a potent vasodilator, hydralazine, to attenuate blood flow in HCC while enhancing it in the surrounding liver tissue. The "steel effect," where blood flow is diverted from the lesion to the surrounding tissue aims to enhance lesion-tissue contrast. Methods: HCC was induced in six rats by oral ingestion of diethylnitrosamine for 12 weeks. 10 tumors were studied to assess the enhancement in HCC tumors and surrounding tissue. Contrast-enhanced ultrasound images (CEUS) of each tumor were acquired before and after hydralazine injection. The enhancement of images was analyzed for the qualitative and quantitative assessment of HCC enhancement. Peak enhancement (PE) was calculated, representing the maximum signal intensity reached during the transit of the contrast bolus for both the tumor and the surrounding tissue. Intravenous administration of hydralazine significantly reduced CEUS signals in HCC tumors. The visual examination of images showed that the enhancement of tumors dramatically decreased after hydralazine injection. On the other hand, the surrounding tissue showed an increased enhancement. PE for the HCC changed from (71.8 ± 5) pre hydralazine to (28.7± 4.9), a 61.7% reduction after hydralazine injection, p=0.01. Future studies validating the technique in clinical settings for enhancing lesion-tissue contrast may allow physicians greater precision and accuracy in HCC surveillance for early detection of small tumors.