Seven Takeaways from New Literature Review on Ultrasound and Hepatocellular Carcinoma
In a new literature review, researchers discussed key considerations with the use of B-mode ultrasound and contrast-enhanced ultrasound in the detection of hepatocellular carcinoma.
Does washout timing play a significant role in differentiating between hepatoceullar carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC)?
Can contrast-enhanced ultrasound (CEUS)-guided biopsies have an impact for liver lesions that elude characterization on B-mode ultrasound?
Does CEUS provide more reliable detection of arterial phase hyper enhancement (APHE) in small HCC lesions than computed tomography (CT) and magnetic resonance imaging (MRI)?
For the answers to these questions and more, here are seven key takeaways from a new literature review on ultrasound and HCC, recently published in the American Journal of Roentgenology.
Here one can see B-mode ultrasound and contrast-enhanced ultrasound images showing a 2.3 cm hypoechoic lesion in a 65-year-old patient with cirrhosis. The lesion was subsequently confirmed as hepatocellular carcinoma (HCC). (Images courtesy of the American Journal of Roentgenology.)
1. A 2024 prospective multinational study showed comparable specificity for the CEUS LR-5 category in small lesions (94.7 percent) and lesions > 20 mm (95.5 percent), but the study authors noted an 18.6 percent higher sensitivity with the > 20 mm lesions (69.3 percent vs. 50.7 percent).
2. The researchers noted mixed findings with respect to washout timing and the use of CEUS LR-5 and LR-M categories in differentiating between HCC and ICC. Emphasizing the high specificity for HCC of CEUS LR-5 category lesions commonly characterized by mild and late washouts, the researchers pointed out a 2020 study indicating that washout within one minute was a key factor in differentiating ICC from HCC. Another 2020 report showed that 14.8 percent of 1,514 HCC cases were CEUS LR-M classifications with 95.5 percent of the CEUS LR-M cases having early washout. A meta-analysis published the same year revealed that HCC was confirmed in 57 percent of lesions categorized as CEUS LR-M.
3. When liver lesions elude characterization on B-mode ultrasound, different studies revealed that CEUS showed washout in 78.5 percent of lesions and had an 88.5 percent technical success rate for guided biopsies.
4. For occult lesions on B-mode ultrasound, the review authors said the combination of CEUS with real-time fusion to a prior CT or MRI can lead to nearly a 40 percent increase in detecting lesions < 1 cm.
5. Emphasizing that unequivocal APHE detection is essential for HCC diagnosis, the review authors noted the CEUS’s continuous real-time imaging enables detection of APHE in a substantial number of instances when it is not apparent on CT or MRI. The researchers pointed out one study in which 26 percent of small HCC lesions had APHE detected by CEUS but not by CT.
6. While B-mode ultrasound provides good detection of hypoechoic lesions in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), the review authors cautioned that hepatic steatosis may hamper visualization of isoechoic and hyperechoic lesions, particularly those with deep localization.
7. When CEUS reveals findings of APHE with mild and late washout in patients with MASLD, the researchers suggested that hepatocellular adenoma and focal nodular hyperplasia are possibilities in the differential diagnosis.
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