Current role of ultrasound in the diagnosis of hepatocellular carcinoma

Abstract

Ultrasonography (US) is a major, sustainable hepatocellular carcinoma (HCC) surveillance method as it provides inexpensive, real-time, and noninvasive detection. Since US findings are based on pathological features, knowledge of pathological features is essential for delivering a correct US diagnosis. Recent advances in US equipment have made it possible to provide more information, such as malignancy potential and accurate localization diagnosis of HCC. Evaluation of malignancy potential is important to determine the treatment strategy, especially for small HCC. Diagnosis of blood flow dynamics using color Doppler and contrast-enhanced US is one of the most definitive approaches for evaluating HCC malignancy potential. Recently, a new Doppler microvascular imaging technique, superb microvascular imaging, which can detect Doppler signals generated by low-velocity blood flow, was developed. A fusion imaging system, another innovative US technology, has already become an indispensable technology over the last few years not only for US-guided radiofrequency ablation but also for the detection of small, invisible HCC. This article reviews the evidence on the use of ultrasound and contrast-enhanced ultrasound with Sonazoid for the practical management of HCC.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Fibroscan and Doppler Ultrasonography in the Assessment of Hepatocellular Carcinoma Interventional Therapy

“…As Doppler ultrasound was proved to be as a reliable and effective method for the evaluation of PHT [15].…”

Image Guidance in Ablation for Hepatocellular Carcinoma: Contrast-Enhanced Ultrasound and Fusion Imaging

“…Prior to ablation therapy, we can use CEUS to assess the HCC lesion size, number, margins, and relationship with the surrounding liver vasculature. The diagnostic accuracy of CEUS (using SonoVue or Sonazoid) for poorly conspicuous HCC is 93.8-100%, similar to contrast-enhanced CT or MRI (21)(22)(23)(24). Thus, CEUS facilitates needle placement in HCC poorly conspicuous on B-mode US, such that the defect/wash-out lesion signifies the target insertion point.…”

Performance of Ultrasound Techniques and the Potential of Artificial Intelligence in the Evaluation of Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease

“…Emerging as the most accurate and cost-effective imaging modality for FLLs characterization, CEUS is currently recommended as the first-line method for hepatic lesions evaluation, especially in patients with inconclusive CT or MRI findings, or among those with contraindications for these techniques [ 61 ]. In addition, recent analyses reported that Sonazoid CEUS surveillance might be a cost-effective method to increase expected survival time among at-risk subjects [ 67 , 91 ]. However, routine use of CEUS for HCC screening among patients at risk is currently not recommended and further research is needed to find ways to integrate such technologies into the healthcare surveillance strategies [ 61 ].…”

“…Broadly available [20] Free from ionizing radiation [21] Cost-effective Non-invasive Typical HCC features of Doppler findings are available [50] The wide variety of Doppler methods (color/spectral/power Doppler) for better assessment of FLLs [47,67] UCAs are safe in adult and pediatric individuals [61] The possibility of re-administration of UCAs for better assessment of suspicious observations [61] Avoids unnecessary further imaging for benign lesions [59] Absence of ionizing radiation [68] Real-time and quantitative assessment [61] Cost-effective […”