Expert consensus regarding the clinical application of liver contrast-enhanced US with Sonazoid (Sonazoid CEUS)

Jianhua Zhou¹, Lingling Li¹, Kun Yan², Yuanyi Zheng³, Tian'An Jiang⁴, Huixiong Xu⁵, Jingyong Xu⁶, Xiang Jing⁷, Haitao Ran⁸, Yu Li¹, Wen Cheng⁹, Xin-Wu Cui¹⁰, Hong Ding¹¹, Jianmin Ding⁷, Yi Dong¹², Wenbin Duan¹³, Hong Han⁵, Guangzhi He¹⁴, Wei He¹⁵, Zhongqian Hu¹⁶, Ying Huang¹⁷, Binkui Li¹⁵, Jie Li¹⁸, Kai-Yan Li¹⁰, Qian Li¹⁹, Fangyi Liu²⁰, Guang-Jian Liu²¹, Liping Liu²², Baoming Luo²³, Wen Luo²⁴, Yan Luo²⁵, Ke Lv²⁶, Xuan Meng²⁷, Li Qiu²⁴, Jie Ren²⁸, Hongguang Wang²⁷, Lijun Wang²⁹, Xi Wei³⁰, Wei Wu², Xiao-Yan Xie³¹, Baocai Xing³², Dong Xu³³, Hong Yang³⁴, Jianhui Yang¹³, Meng Yang²⁶, Jie Yu²⁰, Ming-An Yu³⁵, Xiaoling Yu²⁰, Wei Zheng¹, Zu-Bang Zhou³⁶, Ping Liang²⁰

Affiliations

¹ Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China.
² Department of Ultrasound, Peking University Cancer Hospital, Beijing, China.
³ Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
⁵ Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
⁶ Department of General Surgery, Beijing Hospital, Beijing, China.
⁷ Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.
⁸ Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁹ Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.
¹⁰ Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹¹ Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China.
¹² Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹³ Department of Hepatobiliary Surgery, the People's Hospital of Hunan Province, Changsha, Hunan, China.
¹⁴ Department of Ultrasound, Shenzhen Guangming New District People's Hospital, Shenzhen, China.
¹⁵ Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
¹⁶ Department of Ultrasound, Zhongda Hospital, Southeast University, Nanjing, China.
¹⁷ Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.
¹⁸ Department of Ultrasound, Qilu Hospital, Shandong University, Jinan, China.
¹⁹ Department of Ultrasound, Henan Cancer Hospital, Henan, China.
²⁰ Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
²¹ Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
²² Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
²³ Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
²⁴ Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
²⁵ Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
²⁶ Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²⁷ Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²⁸ Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
²⁹ Department of Hepatopancreatobiliary Surgery Unit I, Peking University Cancer Hospital & Institute, Beijing, China.
³⁰ Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
³¹ Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
³² Department of Hepatic & Biliary Surgery, Peking University Cancer Hospital & Institute, Beijing, China.
³³ Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China.
³⁴ Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
³⁵ Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China.
³⁶ Department of Ultrasound Medicine, Gansu Provincial People's Hospital, Lanzhou, China.

PMID: 40928383
PMCID: PMC12825900
DOI: 10.1097/JS9.0000000000003510

Review

Expert consensus regarding the clinical application of liver contrast-enhanced US with Sonazoid (Sonazoid CEUS)

Jianhua Zhou et al. Int J Surg. 2026.

. 2026 Jan 1;112(1):55-70.

doi: 10.1097/JS9.0000000000003510. Epub 2025 Sep 10.

Authors

Affiliations

¹ Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China.
² Department of Ultrasound, Peking University Cancer Hospital, Beijing, China.
³ Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
⁵ Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
⁶ Department of General Surgery, Beijing Hospital, Beijing, China.
⁷ Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.
⁸ Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁹ Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.
¹⁰ Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹¹ Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China.
¹² Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
¹³ Department of Hepatobiliary Surgery, the People's Hospital of Hunan Province, Changsha, Hunan, China.
¹⁴ Department of Ultrasound, Shenzhen Guangming New District People's Hospital, Shenzhen, China.
¹⁵ Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
¹⁶ Department of Ultrasound, Zhongda Hospital, Southeast University, Nanjing, China.
¹⁷ Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.
¹⁸ Department of Ultrasound, Qilu Hospital, Shandong University, Jinan, China.
¹⁹ Department of Ultrasound, Henan Cancer Hospital, Henan, China.
²⁰ Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
²¹ Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
²² Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
²³ Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
²⁴ Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
²⁵ Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
²⁶ Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²⁷ Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²⁸ Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
²⁹ Department of Hepatopancreatobiliary Surgery Unit I, Peking University Cancer Hospital & Institute, Beijing, China.
³⁰ Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
³¹ Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
³² Department of Hepatic & Biliary Surgery, Peking University Cancer Hospital & Institute, Beijing, China.
³³ Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China.
³⁴ Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
³⁵ Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China.
³⁶ Department of Ultrasound Medicine, Gansu Provincial People's Hospital, Lanzhou, China.

PMID: 40928383
PMCID: PMC12825900
DOI: 10.1097/JS9.0000000000003510

Abstract

Sonazoid, a combined blood pool and Kupffer-cell agent, can be specifically phagocytosed by Kupffer cells in the liver, allowing lesion detection and characterization of focal liver lesions (FLLs) at the post-vascular phase, apart from the vascular phase, which is similar to that of other second-generation ultasound (US) contrast agents. Sonazoid contrast-enhanced US (CEUS) is currently approved for use in some Asian countries. With the increasing use of Sonazoid CEUS for FLLs in clinical practice, developing consensus or guidelines to help standardize its use is required. The expert consensus aimed to review recent evidence and make evidence-based recommendations for radiologists and clinicians involved in the management of liver diseases regarding the use of Sonazoid CEUS in the surveillance or detection, characterization of FLLs, CEUS for interventional and intraoperative use, and tumor treatment response evaluation in patients with FLLs. This consensus was conducted without using artificial intelligence tools in accordance with the TITAN Guidelines 2025.

Keywords: Sonazoid; consensus statement; contrast-enhanced US; liver.

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Conflict of interest statement

None.

References

1. Yanagisawa K, Moriyasu F, Miyahara T, et al. Phagocytosis of ultrasound contrast agent microbubbles by Kupffer cells. Ultrasound Med Biol 2007;33:318–25. - PubMed
1. Shunichi S, Hiroko I, Fuminori M, et al. Definition of contrast enhancement phases of the liver using a perfluoro-based microbubble agent, perflubutane microbubbles. Ultrasound Med Biol 2009;35:1819–27. - PubMed
1. Watanabe R, Matsumura M, Munemasa T, et al. Mechanism of hepatic parenchyma-specific contrast of microbubble-based contrast agent for ultrasonography: microscopic studies in rat liver. Invest Radiol 2007;42:643–51. - PubMed
1. Lee JY, Minami Y, Choi BI, et al. The AFSUMB consensus statements and recommendations for the clinical practice of contrast-enhanced ultrasound using Sonazoid. Ultrason Seoul Korea 2020;39:191–220. - PMC - PubMed
1. Dietrich CF, Nolsøe CP, Barr RG, et al. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol 2020;46:2579–604. - PubMed

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Expert consensus regarding the clinical application of liver contrast-enhanced US with Sonazoid (Sonazoid CEUS)

Affiliations

Expert consensus regarding the clinical application of liver contrast-enhanced US with Sonazoid (Sonazoid CEUS)

Authors

Affiliations

Abstract

Conflict of interest statement

References

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MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical