Journal of Liver Cancer

Review Article

Diagnosis of hepatocellular carcinoma using Sonazoid: a comprehensive review: Woo Kyoung Jeong; J Liver Cancer. 2023;23(2):272-283. Published online September 19, 2023; DOI: https://doi.org/10.17998/jlc.2023.08.25

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Sonazoid contrast-enhanced ultrasonography (CEUS) is a promising technique for the detection and diagnosis of focal liver lesions, particularly hepatocellular carcinoma (HCC). Recently, a collaborative effort between the Korean Society of Radiology and Korean Society of Abdominal Radiology resulted in the publication of guidelines for diagnosing HCC using Sonazoid CEUS. These guidelines propose specific criteria for identifying HCC based on the imaging characteristics observed during Sonazoid CEUS. The suggested diagnostic criteria include nonrim arterial phase hyperenhancement, and the presence of late and mild washout, or Kupffer phase washout under the premise that the early or marked washout should not occur during the portal venous phase. These criteria aim to improve the accuracy of HCC diagnosis using Sonazoid CEUS. This review offers a comprehensive overview of Sonazoid CEUS in the context of HCC diagnosis. It covers the fundamental principles of Sonazoid CEUS and its clinical applications, and introduces the recently published guidelines. By providing a summary of this emerging technique, this review contributes to a better understanding of the potential role of Sonazoid CEUS for diagnosing HCC.

Citations

Citations to this article as recorded by

The Diagnostic Impact of Contrast-Enhanced Computed Tomography (CECT) in Evaluating Lymph Node Involvement in Colorectal Cancer: A Comprehensive Review
Akash Inamdar, Raju K Shinde
Cureus.2024;[Epub] CrossRef
Sonazoid contrast-enhanced ultrasonography for the diagnosis of hepatocellular carcinoma: strengths and shortcomings
Sung Won Lee, Min Kyu Kang, Xiang Zhang
Journal of Liver Cancer.2023; 23(2): 238. CrossRef

Original Article

Diagnostic performance of the 2022 KLCA-NCC criteria for hepatocellular carcinoma on magnetic resonance imaging with extracellular contrast and hepatobiliary agents: comparison with the 2018 KLCA-NCC criteria: Ja Kyung Yoon, Sunyoung Lee, Jeong Ah Hwang, Ji Eun Lee, Seung-seob Kim, Myeong-Jin Kim; J Liver Cancer. 2023;23(1):157-165. Published online February 23, 2023; DOI: https://doi.org/10.17998/jlc.2023.02.07

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Abstract PDF Supplementary Material

Background/Aim
This study aimed to determine the diagnostic performance of 2022 Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) imaging criteria compared with the 2018 KLCA-NCC for hepatocellular carcinoma (HCC) in high-risk patients using magnetic resonance imaging (MRI).
Methods
This retrospective study included 415 treatment-naïve patients (152 patients who underwent extracellular contrast agent [ECA]-MRI and 263 who underwent hepatobiliary agent [HBA]-MRI; 535 lesions, including 412 HCCs) with a high risk of HCC who underwent contrast-enhanced MRI. Two readers evaluated all lesions according to the 2018 and 2022 KLCA-NCC imaging diagnostic criteria, and the per-lesion diagnostic performances were compared.
Results
In “definite” HCC category of both 2018 and 2022 KLCA-NCC, HBA-MRI showed a significantly higher sensitivity for the diagnosis of HCC than ECA-MRI (77.0% vs. 64.3%, P=0.006) without a significant difference in specificity (94.7% vs. 95.7%, P=0.801). On ECAMRI, “definite” or “probable” HCC categories of the 2022 KLCA-NCC had significantly higher sensitivity than those of the 2018 KLCA-NCC (85.3% vs. 78.3%, P=0.002) with identical specificity (93.6%). On HBA-MRI, the sensitivity and specificity of “definite” or “probable” HCC categories of both 2018 and 2022 KLCA-NCC were not significantly different (83.3% vs. 83.6%, P>0.999 and 92.1% vs. 90.8%, P>0.999, respectively).
Conclusions
In “definite” HCC category of both 2018 and 2022 KLCA-NCC, HBA-MRI provides better sensitivity than ECA-MRI without compromising specificity. On ECA-MRI, “definite” or “probable” HCC categories of the 2022 KLCA-NCC may improve sensitivity in the diagnosis of HCC compared with the 2018 KLCA-NCC.

Citations

Citations to this article as recorded by

Impact of the updated KLCA-NCC criteria for diagnosis of “probable HCC” in liver MRI: comparisons between KLCA v2022 and v2018
Jeong Hee Yoon
Journal of Liver Cancer.2023; 23(1): 124. CrossRef

Review Article

Contrast-enhanced Ultrasonography: The Third Modality for Differentiation of Liver Mass: Min Kyu Kang, Moon Young Kim, Seong Hee Kang, Soon Koo Baik; J Liver Cancer. 2019;19(2):91-96. Published online September 30, 2019; DOI: https://doi.org/10.17998/jlc.19.2.91

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Abstract PDF

Contrast-enhanced ultrasonography (CEUS) using microbubble ultrasonography contrast agent can show the vascular structure and unique contrast enhancement patterns of focal liver lesions, including hepatocellular carcinoma (HCC). CEUS shows three phases, similar to a vascular pattern on computer tomography (CT), and typical arterial enhancement and portal or late phase washout in HCC. CEUS can show real-time images without nephrotoxicity or radiation hazard and can be used as guidance for loco-regional treatment and estimation of treatment response of HCC. In addition, some data recently revealed the usefulness of CEUS in the early estimation of response to anti-cancer pharmacological (i.e., sorafenib) therapy in advanced HCC. Although CEUS has limitations in clinical practice and more investigation is needed for its validation, it is recommended as a main diagnostic modality in a few major clinical practice guidelines for HCC. Thus, greater understanding of CEUS is necessary to extend its application in real practice for diagnosis and management of diseases.

Citations

Citations to this article as recorded by

Perfluorobutane-Enhanced Ultrasound for Characterization of Hepatocellular Carcinoma From Non-hepatocellular Malignancies or Benignancy: Comparison of Imaging Acquisition Methods
Seungchul Han, Se Woo Kim, Sungeun Park, Jeong Hee Yoon, Hyo-Jin Kang, Jeongin Yoo, Ijin Joo, Jae Seok Bae, Jeong Min Lee
Ultrasound in Medicine & Biology.2023; 49(10): 2256. CrossRef

Original Article

Diagnostic Performance of Diffusion-weighted Imaging for Hepatic Neuroendocrine Tumor: Comparison with Combined Diffusion-weighted Imaging and Contrast-enhanced Magnetic Resonance Imaging: Suk Ki Jang, Jung Hoon Kim, Mi Hye Yu, Joon Koo Han; J Liver Cancer. 2016;16(2):92-100. Published online September 30, 2016; DOI: https://doi.org/10.17998/jlc.16.2.92

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Abstract PDF: Background/Aims
To investigate the diagnostic performance of diffusion-weighted imaging (DWI) for hepatic neuroendocrine tumors (NET) compared with combined DWI and contrastenhanced magnetic resonance imaging (MRI) .
Methods
Fifteen patients with hepatic NET (n=128) underwent enhanced MRI and DWI with multiple-b values. We analyzed three different sets: Precontrast set; DWI set (added DWI); combined set (added enhanced image). Two reviewers rated possibility of NET using a 5-point scale for each image set. Their diagnostic performance was compared using Jackknife alternative free-response ROC (JAFROC).
Results
Diagnostic performance was better on the combined set (figure of merit [FOM]=0.852, 0.761) than the precontrast set (FOM=0.427, 0.572, P<0.05) and the DWI set (FOM=0.682, 0.620, P<0.05). However, DWI improved performance compared with precontrast set without statistical difference. In small NETs (<1 cm), all sets showed low sensitivity (10.7-65.9%) with high specificity (95.4-100%). Interobserver agreement was moderate in all image sets (k=0.521 to 0.589).
Conclusions
Combined DWI and enhanced MRI were more useful for detecting NET. Although statistically insignficant, there was a trend in improved diagnostic performance with DWI.

Review Article

New Techniques of Ultrasound-guided Radiofrequency Ablation for Hepatocellular Carcinoma: Min Woo Lee; J Liver Cancer. 2014;14(2):89-96. Published online September 30, 2014; DOI: https://doi.org/10.17998/jlc.14.2.89

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Abstract PDF: In Korea, radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is most widely used under ultrasonography (US) guidance. With the technical development, small HCCs in challenging locations can be ablated effectively. Both fusion imaging and contrast-enhanced US is useful for identifying small inconspicuous HCCs on conventional US, thereby enable us to conduct successful RFA. Artificial ascites can enhance ultrasonic window and is helpful in avoiding thermal injury to the surrounding organs. Laparoscopy is also useful for guidance of RFA for subcapsular HCCs which are difficult to approach percutaneously. (J Liver Cancer 2014;14:89-96)

Original Article

Follow-up of Hepatocellular Carcinoma After Transarterial Chemoembolization; The Concordance of Contrast Enhanced Ultrasonography and Lipiodol CT: Gene Hyun Bok, Soung Won Jeong, Jae Young Jang, Sae Hwan Lee, Sang Gyune Kim, Sang-Woo Cha, Young Seok Kim, Young Deok Cho, Hong Soo Kim, Boo Sung Kim; J Liver Cancer. 2014;14(2):115-119. Published online September 30, 2014; DOI: https://doi.org/10.17998/jlc.14.2.115

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Abstract PDF: Background/Aims
The aim of this study is to evaluate the concordance of contrast-enhanced ultrasonography (CEUS) and lipiodol computed tomography (L-CT) for the assessment of viable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).
Methods
We retrospectively reviewed the post-TACE CEUS and L-CT images of 65 consecutive HCCs in 41 patients to assess the presence of viable tumor tissue. Forty-seven HCCs in 31 patients that underwent post-TACE L-CT within 4 weeks of the CEUS examination were included. The degree of concordance between CEUS and L-CT and factors related to concordance were analyzed.
Results
The overall concordance of CEUS and LDCT was 78.7% (37/47). The concordance with L-CT for viable tumor and non-viable tumor tissue on CEUS was 95.2%, and 65.4% respectively (P<0.013). Diffuse tumors had a tendency for non-concordance (P=0.066). Although 3 of 4 lesions located in the hepatic dome were non-concordant, the sample size was too small to establish significance. The mean tumor size for concordant and non-concordant tumors was 2.9 and 3.0 cm, with no significant difference.
Conclusions
Although the concordance of CEUS and L-CT for viable tumor tissue was high, the concordance for non-viable tumor tissue was relatively low. Prospective studies using angiography as a gold standard should be performed in the future. (J Liver Cancer 2014;14:115-119)

Review Articles

The Usefulness of Contrast-Enhanced Ultrasonography in the Diagnosis of Hepatocellular Carcinoma: Moon Young Kim; Journal of the Korean Liver Cancer Study Group. 2014;14(1):7-13. Published online March 31, 2014; DOI: https://doi.org/10.17998/jlc.14.1.7

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Abstract PDF: Contrast enhanced ultrasonography (CEUS) using microbubble ultrasonography agent is able to show the vascular structure and enhancement patterns of lesions, so it has an worth in the diagnosis of hepatocellular carcinoma (HCC) which is a typical cancer that has a characteristic neovascularization. CEUS shows 3 phase vascular pattern like computer tomography (CT) typical arterial enhancement and portal or late wash out in HCC. CEUS can show a enhancement pattern of HCC in a real time and it has no nephrotoxicity or radiation hazard. Beyond the diagnosis, CEUS has also shown usefulness in the guidance of locoregional treatment and estimation of treatment response of HCC. In addition, recently, a few data which show a usefulness of CEUS in the early estimation of response after target therapy in the advanced HCC, also have been reported. However, CEUS has limitations in clinical practice yet and more wide investigation is needed for the validation of usefulness and wide application in clinical practice. However, CEUS also has many advantages in the field of the diagnosis and management of HCC, so in in this review, we are going to introduce CEUS and overview its clinical usefulness briefly.

Diagnostic Performance of CT and MRI for Small HCC Less Than 1 cm: Jung Hoon Kim; Journal of the Korean Liver Cancer Study Group. 2013;13(2):105-113. Published online September 30, 2013; DOI: https://doi.org/10.17998/jlc.13.2.105

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Abstract PDF: Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Worldwide, the surveillance program of HCC is well-established for the patients with high risk. The early stage of HCC has the highest likelihood for cure. It is therefore important to make the early diagnosis of HCC. The imaging criteria for the diagnosis of HCC have established detailing the characteristic enhancement pattern of HCC including hypervascularity in the arterial phase and washout in the portal or delayed phase of dynamic imaging. However, in the current practical guidelines, there are controversies for HCC smaller than 1 cm in size because of the low sensitivity of CT and MR for HCC smaller than 1 cm in size. Recent advances in CT and MR hardware and software allow for rapid acquisition times that can reduce many of motion artifacts. Furthermore, recently introduced hepatocyte-specific MR contrast agents have showed its superior efficacy in both detection and characterization of small focal liver lesion by providing both dynamic imaging and hepatobiliary phase imaging. So, we reviewed the diagnostic performance of CT and MRI for HCC smaller than 1 cm in size. In addition, we introduced our experience for HCC smaller than 1 cm in size.

Technical Advances in Radiofrequency Ablation of Hepatocellular Carcinoma: Dongil Choi, Hyunchul Rhim, Min Woo Lee; Journal of the Korean Liver Cancer Study Group. 2012;12(1):14-15. Published online February 28, 2012

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Abstract PDF: Lots of recent technical advances in radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) have introduced. First, contrast-enhanced ultrasound can help to detect the index tumors, residual tumor, and local recurrence. After contrast-enhanced ultrasound for subtle small tumors, we can perform RFA with high confidence. The use of artificial ascites in RFA is a simple and useful technique to minimize collateral thermal injury and to improve the sonic window. Fusion imaging between US and CT or MR during RFA is useful since US can provide real-time imaging and CT or MR provides high quality images with good contrast and spatial resolution. RFA can be performed with fluoroscopy guidance to lipiodol retention tumors.

Hypervascular hepatic nodules which needs to be differentiated from hepatocellular carcinoma: Mi-Suk Park, Ki Whang Kim; Journal of the Korean Liver Cancer Study Group. 2007;7(1):1-7. Published online June 30, 2007

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Abstract PDF: The frequency of hepatic nodular lesion detection has increased due to recent advances in imaging diagnostic techniques. There are many hypervascular hepatic nodules which need to be differentiated from hepatocellular carcinoma. Of these lesions, hepatic adenoma, focal nodular hyperplasia, nodular regenerative hyperplasia, and focal nodular hyperplasia-like nodules will be described in this review article. All of them are hypervascular and so it is needed to differentiate hepatocellular carcinoma.

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