Contrast-Enhanced Ultrasound for Hepatocellular Carcinoma Diagnosis-<i>AJR</i> Expert Panel Narrative Review.
Authors
Affiliations (10)
Affiliations (10)
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, China.
- Université Paris Cité, Inserm, Centre de recherche sur l'inflammation, F-75018 Paris, France.
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France.
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, E6-230-BF, Dallas, TX 75390-9316, USA.
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Campus della Salute c/o Policlinico San Matteo, Viale Golgi 19, Pavia, Italy.
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
- Casa di Cura Villa Igea, Department of Interventional Ultrasound, Casa di Cura Igea, Milan, Italy.
- Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London UK; Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London UK.
- Division of Gastroenterology, University of Calgary, Calgary, Canada.
Abstract
Despite growing clinical use of contrast-enhanced ultrasound (CEUS), inconsistency remains in the modality's role in clinical pathways for hepatocellular carcinoma (HCC) diagnosis and management. This AJR Expert Panel Narrative Review provides practical insights on the use of CEUS for the diagnosis of HCC across populations, including individuals at high risk for HCC, individuals with metabolic dysfunction-associated steatotic liver disease, and remaining individuals not at high risk for HCC. Considerations addressed with respect to high-risk patients include CEUS diagnostic criteria for HCC, use of CEUS for differentiating HCC from non-HCC malignancy, use of CEUS for small (≤2 cm) lesions, use of CEUS for characterizing occult lesions on B-mode ultrasound, and use of CEUS for indeterminate lesions on CT or MRI. Representative literature addressing the use of CEUS for HCC diagnosis as well as gaps in knowledge requiring further investigation are highlighted. Throughout these discussions, the article distinguishes two broad types of ultrasound contrast agents used for liver imaging: pure blood-pool agents and a combined blood-pool and Kupffer-cell agent. Additional topics include the use of CEUS for treatment response assessment after nonradiation therapies and implications of artificial intelligence technologies. The article concludes with a series of consensus statements from the author panel.