Feasibility 3D Perfusion Ultrasound for Liver Cancer SABR Planning and Response Evaluation

Primary Objective:

The primary objectives of this prospective pilot study is to:

1. determine the feasibility and reproducibility of 3D contrast enhanced ultrasound imaging
in liver cancer patients undergoing Stereotactic Ablative Radiotherapy and

2. evaluate whether there are treatment induced early changes in imaging metrics derived
from 3D contrast enhanced ultrasound. This study will provide valuable insight as to the
potential of baseline and/or early post-treatment 3D ultrasound perfusion
characteristics (measurements of blood-flow) of primary and metastatic liver tumors to
predict tumor response to Stereotactic Ablative Radiotherapy. The investigators'
underlying goal is to assess whether early perfusion changes at 1-7 days after SABR
initiation can be used as a non-invasive early biomarker for treatment response
assessment.

Secondary Objectives:

Evaluate the feasibility of contrast-enhanced ultrasound-to-CT fusion by assisting
three-dimensional (3D) perfusion ultrasound (US) imaging with optical and electromagnetic
tracking of the ultrasound probe on patients with liver cancer that will undergo CT for
treatment planning and/or response evaluation.

Inclusion Criteria:

- Ability to understand and willingness to sign the written informed consent document

- Patient with primary liver tumor or metastasis scheduled for Stereotactic Ablative
Radiotherapy (SABR)

- Patient is at least 18 years of age. No gender/race-ethnic restrictions.

- Performance status (ECOG) between 0-3

- History and Physical done within 4 weeks of enrollment.

Exclusion Criteria:

- Patient has previously been enrolled in and completed this study.

- Known right to left cardiac shunt, bidirectional or transient.

- Patient has any medical condition or other circumstances which would significantly
decrease the chances of obtaining reliable data, achieving study objectives, or
completing the study and/or post-dose follow-up examinations.

- History of hypersensitivity to the contrast agent perflutren

- History of pulmonary hypertension

- Patients who are pregnant or are trying to become pregnant