Contrast-Enhanced Ultrasound for Hepatocellular Carcinoma Diagnosis- Expert Panel Narrative Review.

Journal: AJR. American journal of roentgenology
Published Date: May 28, 2025

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.

Authors

  • Lingling Li
    College of Biological Science and Engineering, Fuzhou University, No. 2 Xue Yuan Road, University Town, Fuzhou, Fujian 350108, China.
  • Marco Dioguardi Burgio
    Université Paris Cité, Inserm, Centre de recherche sur l'inflammation, F-75018 Paris, France.
  • David T Fetzer
    From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.).
  • Giovanna Ferraioli
    Medical School University of Pavia, Pavia, Italy giovanna.ferraioli@unipv.it.
  • Andrej Lyshchik
    Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
  • Maria Franca Meloni
    Casa di Cura Villa Igea, Department of Interventional Ultrasound, Casa di Cura Igea, Milan, Italy.
  • Vasileios Rafailidis
    Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
  • Paul S Sidhu
    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.
  • Valerie Vilgrain
    Université Paris Cité and Department of Radiology, Hôpital Beaujon, APHP.Nord, Paris, France.
  • Stephanie R Wilson
    Division of Gastroenterology, University of Calgary, Calgary, Canada.
  • Jianhua Zhou
    Department of Ultrasound, Sun Yat-sen University Cancer centre, State Key Laboratory of Oncology in South China, Collaborative Innovation centre for Cancer Medicine, Guangzhou, China.

Keywords

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