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.
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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.