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

Area of Science:

• Radiology
• Hepatology
• Medical Imaging

Background:

• Contrast-enhanced ultrasound (CEUS) is increasingly used for hepatocellular carcinoma (HCC) diagnosis, but its clinical role lacks standardization.
• Existing diagnostic pathways for HCC require clarification regarding the optimal integration of CEUS.
• Variability in CEUS contrast agents and interpretation criteria impacts its consistent application.

Purpose of the Study:

• To provide practical insights and consensus statements on the use of CEUS for HCC diagnosis and management.
• To address the application of CEUS across diverse patient populations, including high-risk individuals and those with metabolic dysfunction-associated steatotic liver disease.
• To review CEUS criteria for HCC, differentiation from other malignancies, and characterization of small or indeterminate liver lesions.

Main Methods:

• Expert panel narrative review synthesizing current literature on CEUS for HCC.
• Discussion of CEUS diagnostic criteria, lesion characterization, and differentiation from non-HCC malignancies.
• Comparison of pure blood-pool agents versus combined blood-pool and Kupffer-cell agents for liver imaging.

Main Results:

• CEUS demonstrates utility in diagnosing HCC across various risk groups and lesion types (e.g., small, occult, indeterminate).
• Specific CEUS features aid in differentiating HCC from other malignant liver lesions.
• The review highlights knowledge gaps and discusses the role of CEUS in treatment response assessment and AI integration.

Conclusions:

• Standardized application of CEUS can improve HCC diagnosis and management consistency.
• CEUS offers a valuable tool for characterizing liver lesions, particularly in high-risk populations.
• Further research and consensus are needed to fully integrate CEUS into routine clinical practice for HCC.