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World J Radiol. Jan 28, 2014; 6(1): 7-14
Published online Jan 28, 2014. doi: 10.4329/wjr.v6.i1.7
Management of hepatocellular carcinoma: The role of contrast-enhanced ultrasound
Shu-Guang Zheng, Hui-Xiong Xu, Lin-Na Liu
Shu-Guang Zheng, Hui-Xiong Xu, Lin-Na Liu, Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Shanghai 200072, China
Author contributions: Zheng SG, Xu HX and Liu LN conducted literature research; Zheng SG wrote the paper; Liu LN prepared the figure; Xu HX edited and revised the paper.
Supported by National Natural Science Foundation of China, Nos. 81371570, 81301229 and 81301299; Key Project from Shanghai Health Bureau, No. 20114003; Shanghai Talent Development Project from Shanghai Human Resource and Social Security Bureau, No. 2012045
Correspondence to: Hui-Xiong Xu, MD, PhD, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tenth People’s Hospital of Tongji University, No. 301 Yanchangzhong Road, Shanghai 200072, China.
Telephone: +86-21-66301031 Fax: +86-21-66301031
Received: June 23, 2013
Revised: October 31, 2013
Accepted: November 15, 2013
Published online: January 28, 2014

Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third cause of cancer death worldwide. Contrast enhanced ultrasound (CEUS) has been applied for more than ten years and plays increasingly important roles in the management of HCC. On the basis of the Guideline and Good Clinical Practice Recommendations for CEUS in the liver-update 2012 and related literature about the management of HCC, we summarize the main roles and applications of CEUS in the management of HCC, including HCC surveillance, diagnosis, CEUS-guided treatment, treatment response evaluation and follow-up. The diagnostic algorithm for HCC is also suggested. Meanwhile, the comparisons between CEUS and contrast enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) in these areas are made. Although CEUS is subject to the same limitation as ordinary US and is inferior to CECT/CEMRI in some aspects, CEUS has proved to be of great value in the management of HCC with inherent advantages, such as sufficient high safety profile making it suitable for patients with renal failure or allergic to iodine, absence of radiation, easy reproducibility and high temporal resolution. The tremendous application of CEUS to the diagnosis and treatment of HCC provides more opportunities for patients with HCC diagnosed at different stages.

Keywords: Hepatocellular carcinoma, Contrast enhanced ultrasound, Ultrasound contrast agent, Imaging, Sonography

Core tip: Whether contrast enhanced ultrasound (CEUS) is comparable to contrast enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) in the management of hepatocellular carcinoma (HCC) is a controversial topic recently. Regarding to this issue, we list almost all the updated applications of CEUS in this paper and discuss the main role of CEUS in the management of HCC by comparison with CECT/CEMRI.