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Eur J Radiol. 2015 Sep;84(9):1623-35. doi: 10.1016/j.ejrad.2015.05.020. Epub 2015 May 22.

CEUS: An essential component in a multimodality approach to small nodules in patients at high-risk for hepatocellular carcinoma.

Author information

1
Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada. Electronic address: Hyun-Jung.jang@uhn.ca.
2
Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada. Electronic address: Taekyoung.Kim@uhn.ca.
3
Department of Imaging Research, University of Toronto, Sunnybrook Health Sciences centre, 2075 Bayview Avenue, Toronto ON M4 N 3M5, Canada. Electronic address: burns@sri.utoronto.ca.
4
Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB T2R 1M5, Canada. Electronic address: Stephanie.wilson@albertahealthservices.ca.

Abstract

Contrast-enhanced ultrasound (CEUS) plays an essential role in the evaluation of small nodules in livers at high-risk for hepatocellular carcinoma (HCC) and offers unique advantages over CT/MRI. These include the sensitive depiction of arterial hypervascularity of HCC, better demonstration of rapid washout for non-HCC malignancy as well as of very late washout of HCC. Visualization of early vascular filling patterns for benign hypervascular lesions is of indisputable value. A frequently uncounted benefit of CEUS includes the value of its performance following nodule detection at ultrasound surveillance, including one-stop exclusion of typical benignancy, preclusion of arterial pseudolesions shown on CT/MR, and the avoidance of miscorrelation of a nodule on surveillance and subsequent diagnostic imaging. Therefore, CEUS can effectively be used in the diagnostic algorithm for new liver nodules detected during HCC surveillance. Despite the fact that CEUS is actively used as a major diagnostic test for HCC in Asia, Europe, and Canada with increasing demands in clinical practice, CEUS is not included in the diagnostic tests for HCC in some major practice guidelines. In this manuscript, we focus on small nodules in patients at high-risk for HCC, and review some of the unique advantages of CEUS that contribute to lesion characterization and subsequent patient management, showing why CEUS should be an essential component of the diagnostic algorithm for HCC.

KEYWORDS:

CEUS; HCC surveillance; Hepatocellular carcinoma; Intrahepatic cholangiocarcinoma; Liver: Tumor

PMID:
26092406
DOI:
10.1016/j.ejrad.2015.05.020
[Indexed for MEDLINE]

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