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Review
. 2016 Feb;5(1):55-66.
doi: 10.1159/000367748. Epub 2015 Dec 18.

Imaging Diagnosis of Hepatocellular Carcinoma: Recent Advances of Contrast-Enhanced Ultrasonography with SonoVue®

Veronica Salvatore  1 , Alice Gianstefani  1 , Giulia Negrini  1 , Giulia Allegretti  1 , Marzia Galassi  1 , Fabio Piscaglia  1
Affiliations
Review

Imaging Diagnosis of Hepatocellular Carcinoma: Recent Advances of Contrast-Enhanced Ultrasonography with SonoVue®

Veronica Salvatore et al. Liver Cancer. 2016 Feb.

Abstract

Due to the ability to detect the typical contrast-imaging pattern for hepatocellular carcinoma (HCC), that is hyperenhancement in the arterial phase and hypoenhancement in the late phase on a cirrhotic background, contrast-enhanced ultrasonography (CEUS) was included in the American diagnostic algorithm for HCC in 2005. However, its role has been questioned because of the possibility of misdiagnosis of cholangiocarcinoma. The present review aims to describe the advantages and disadvantages of CEUS applications using Sonovue® for HCC. In particular there is focus on the accuracy of CEUS in detecting the typical HCC pattern, the CEUS patterns of intrahepatic cholangiocarcinoma (ICC), the risk of misdiagnosis with HCC, the diagnostic use of CEUS in cases of locoregional and systemic treatments, and the evaluation of response to antiangiogenic treatment using dedicated software.

Keywords: Cholangiocarcinoma; Cirrhosis; Diagnosis; Hepatocellular carcinoma; Treatment.

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Figures

Fig. 1
Fig. 1
Typical HCC pattern. CEUS of a hypoechoic lesion (arrow) in cirrhosis (a) demonstrates a marked hyperenhancement in the arterial phase (b) followed by wash-out in the late venous phase (c).
Fig. 2
Fig. 2
CEUS examination one month after TACE for HCC. In (a), intratumoral localized enhancement in the arterial phase is evident in the lower part of the nodule followed by wash-out (b) in the late phase, a pattern indicative of limited residual tumor viability.
Fig. 3
Fig. 3
Quantification of enhancement under antiangiogenenic treatment. US contrast enhancement quantification, using a dedicated software before starting sorafenib treatment (a) and at two weeks post-treatment (b) indicates a reduction in the arterial enhancement and tumor perfusion (see curves under the ultrasound images). CT examination performed at baseline (c) the arrow indicates the active HCC and is the target of systemic treatment) and after two months of treatment (d) demonstrates stable disease according to dimensional criteria, with some increase of the nonperfused hypodense areas.
See this image and copyright information in PMC

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