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World J Hepatol. May 27, 2022; 14(5): 911-922
Published online May 27, 2022. doi: 10.4254/wjh.v14.i5.911
Loco-regional treatment of hepatocellular carcinoma: Role of contrast-enhanced ultrasonography
Agostino Inzerillo, Maria Franca Meloni, Adele Taibbi, Tommaso Vincenzo Bartolotta
Agostino Inzerillo, Adele Taibbi, Tommaso Vincenzo Bartolotta, Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
Maria Franca Meloni, Department of Radiology, Casa di Cura Igea, Milan 20121, Italy
Tommaso Vincenzo Bartolotta, Department of Radiology, Fondazione Istituto G. Giglio Hospital, Cefalù 90015, Italy
Author contributions: Inzerillo A, Meloni MF, Taibbi A and Bartolotta TV contributed equally to this work; all authors have read and approved the final manuscript.
Conflict-of-interest statement: Tommaso Vincenzo Bartolotta: Lecturer for Samsung.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tommaso Vincenzo Bartolotta, MD, PhD, Full Professor, Director, Professor, Department of Radiology, University Hospital "Paolo Giaccone", Via del Vespro 129, Palermo 90127, Italy. tommasovincenzo.bartolotta@unipa.it
Received: February 25, 2021
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
Abstract

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.

Keywords: Hepatocellular carcinoma, Contrast-enhanced ultrasonography, Radiofrequency ablation, Transcatheter arterial chemoembolization, Ultrasound, Liver

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.