Published online May 27, 2022. doi: 10.4254/wjh.v14.i5.911
Peer-review started: February 25, 2021
First decision: May 13, 2021
Revised: May 26, 2021
Accepted: April 20, 2022
Article in press: April 20, 2022
Published online: May 27, 2022
Processing time: 452 Days and 13 Hours
Hepatocellular carcinoma (HCC) is one of the few cancers for which locoregional treatments (LRTs) are included in international guidelines and are considered as a valid alternative to conventional surgery. According to Barcelona Clinic Liver Cancer classification, percutaneous treatments such as percutaneous ethanol injection, radiofrequency ablation and microwave ablation are the therapy of choice among curative treatments in patients categorized as very early and early stage, while transcatheter arterial chemoembolization is considered the better option for intermediate stage HCC. A precise assessment of treatment efficacy and surveillance is essential to optimize survival rate, whereas residual tumor requires additional treatment. Imaging modalities play a key role in this task. Currently, contrast-enhanced computed tomography/magnetic resonance imaging are considered the standard imaging modalities for this purpose. Contrast enhanced ultrasound (CEUS), using second generation contrast agents, plays an increasingly important role in detecting residual disease after LRTs. CEUS is a straightforward to perform, repeatable and cost-effective imaging modality for patients with renal failure or iodine allergies. Due to the ability to focus on single regions, CEUS can also provide high temporal resolution. Moreover, several studies have reported the same or better diagnostic accuracy as contrast-enhanced computed tomography for assessing tumor vascularity 1 mo after LRTs, and recently three-dimensional (3D)-CEUS has been reported as a promising technique to improve the evaluation of tumor response to therapy. Furthermore, CEUS could be used early after procedures in monitoring HCC treatments, but nowadays this indication is still debated, and data from literature are conflicting, especially after transcatheter arterial chemoembolization procedure.
Core Tip: Contrast enhanced ultrasound (CEUS) is playing an increasingly important role to evaluate locoregional treatments efficacy in hepatocellular carcinoma. In this paper, on the basis of personal experience and the relevant literature, we will review and discuss the CEUS technique. We will also highlight the importance of CEUS in evaluating the efficacy and post-procedural surveillance and their efficacy compared to the gold standard contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging.