Advances in Imaging Diagnosis of Hepatocellular Carcinoma - the Place of Contrast Enhanced Ultrasound (CEUS)

Hepatocellular carcinoma (HCC) is a primary malignant liver tumor that complicates advanced chronic liver disease, especially liver cirrhosis. Surveillance of this category of patients is mandatory for early detection of HCC and improved prognosis. Screening should be carried out by the abdominal US every 6 months with or without alpha-fetoprotein. The diagnosis of HCC is confirmed by imaging methods that highlight the typical behavior of HCC: hyper-enhancement in the arterial phase and washout in the late phase. Imaging methods used for HCC diagnosis are Multi-detector computer tomography (MDCT), multi-phase nuclear magnetic resonance imaging (MRI), or contrast-enhanced ultrasound (CEUS). LI-RADS algorithm is now one of the most used widely systems for the imaging diagnosis of HCC. It is a standardized system for technique, interpretation, reporting, and data collection for imaging (CT, MRI, and CEUS). The algorithm includes 8 categories with an increasing probability of HCC and malignancy with higher categories. Studies that have attempted to validate this LI-RADS scheme for the diagnosis of HCC shown that LR-5 is highly predictive for HCC.

Keywords: Contrast-enhanced ultrasound, Diagnosis, Hepatocellular carcinoma, Liver cirrhosis, Liver Imaging Reporting and Data System, Magnetic resonance imaging, Multi-detector computer tomography.