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Advanced Ultrasound in Diagnosis and Therapy ›› 2025, Vol. 9 ›› Issue (4): 375-387.doi: 10.26599/AUDT.2025.250094

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  • 收稿日期:2025-09-12 修回日期:2025-09-24 接受日期:2025-10-20 出版日期:2025-12-30 发布日期:2025-11-06

The Evolving Application of Ultrasound in the Precision Management of Small Hepatocellular Carcinoma

Guan Xina,1, Hu Xinyuanb,1, Han Hongb, Zhang Dezhic,*(), Xu Huixionga,*()   

  1. aDepartment of Ultrasound, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
    bDepartment of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
    cAbdominal Ultrasound Department, Diagnostic Ultrasound Center, First Hospital of Jilin University, Jilin, P. R. China
  • Received:2025-09-12 Revised:2025-09-24 Accepted:2025-10-20 Online:2025-12-30 Published:2025-11-06
  • Contact: Abdominal Ultrasound Department, Diagnostic Ultrasound Center, First Hospital of Jilin University, Jilin, P. R. China (Dezhi Zhang), e-mail: dezhi@jlu.edu.cn (DZ Z);Department of Ultrasound, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361000, China (Huixiong Xu),e-mail: xuhuixiong@126.com (HX X).
  • About author:1Xin Guan and Xinyuan Hu contributed equally to this study.

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Abstract:

Early detection of hepatocellular carcinoma (HCC) is crucial, as patient outcomes depend largely on clinical stage and treatment options at diagnosis. Currently most clinical guidelines emphasize non-invasive cross-sectional imaging for HCC diagnosis and evaluation, yet the full potential of ultrasound is often underexplored. With the development of emerging ultrasound techniques and diagnostic algorithms in recent years, the diagnostic ability of ultrasound for HCC smaller than 3 cm has been substantially improved and is increasingly emphasized in the management of small HCC. Following sequential clinical scenarios, this review discusses the state-of-the-art of ultrasound-related techniques and algorithms for preoperative screening and diagnosis, intraoperative guidance and monitoring as well as posttreatment efficacy evaluation of small HCC. By highlighting how advanced ultrasound complements and enhances standard practices, this review aims to promote ultrasound as an indispensable, versatile, and dynamic tool in the precision management of small HCC.

Key words: Ultrasound, Contrast-enhanced ultrasound, Small hepatocellular carcinoma, Diagnosis and treatment, Fusion imaging

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GuidelinesEASLAASLDAPASLCSHKLCAJSH
EASL, the European Association for the Study of the Liver; AASLD, the American Association for the Study of Liver Diseases; APASL, the Asia-Pacific Association for the Study of the Liver; CSH, the Chinese Society for the Study of the Liver; KLCA-NCC, the Korean Liver Cancer Association-National Cancer Center; JSH, the Japanese Society for the Study of the Liver; CT, computed tomography; MRI, magnetic resonance imaging; CEUS, con trast-enhanced ultrasound; HBA, hepatobiliary agents; LI-RADS, Liver Imaging Reporting and Data System.
Imaging modalityCT/MRICT/MRICT/MRI/CEUSCT/MRI/CEUSCT/MRI/CEUSCT/MRI/CEUS
CEUS roleSecondarySecondaryFirst-lineFirst-lineFirst-lineFirst-line
HBA-MRI roleRecognized, optionalRecognized, optionalRecognized, optionalRecommended,
widely used		Integral to algorithmIntegral to algorithm
Diagnostic algorithmEASL CriteriaLI-RADSAPASL CriteriaChina CriteriaKLCA CriteriaJSH Criteria
Diagnosis for ≤ 2 cm noduleTypical pattern on
1 technique		Typical pattern on
1 technique		Typical pattern on
1 technique		Typical pattern on
1 technique		Typical pattern on
1 technique		Often typical pattern on 1 technique
Biopsy for atypical
≤ 2 cm nodule		RecommendedRecommendedConsider alternative imaging firstConsider alternative imaging firstConsider alternative imaging firstConsider alternative imaging first

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ModalitiesFunctionAdvantagesLimitations
US, ultrasound; LI-RADS, Liver Imaging Reporting and Data System; HCC, hepatocellular carcinoma; CEUS, contrast-enhanced ultrasound; CT, computed tomography; MRI, magnetic resonance imaging; APHE, arterial phase hyperenhancement; TRA, treatment response assessment.
B-mode USTo detect and characterize lesion as well as to assess adjacent invasionFirst-line tool for screeningSuboptimal sensitivity
Suboptimal specificity
Influenced by patient, operator and ultrasonic device conditions
US LI-RADSTo standardize B-mode US interpretation, reporting and treatment recommendations in patients at high-risk of HCCUS category score determines follow-up management
US visualization score conveys expected sensitivity level of US test
Moderate-to-good intra-observer agreement		Lack of management recommendations based on visualization scores
Confounding factors: overweight, Child-Pugh class B disease, and moderate to severe fatty liver
Traditional Doppler US
To visualize the nature, direction and velocity of blood flow as well as to display its adjacency to intrahepatic vesselsResistance index aids in differential diagnosis of malignancyHard to detect fine blood flow
High false negative rate
Heartbeat interference
Microvascular USTo detect slow-velocity flow and to visualize smaller vessel flowHigh vascular sensitivity
High spatial resolution
Excellent interobserver agreement
Reduced motion artifact		Angle dependent
Cannot provide directional flow and quantitative evaluation
Confounding factors (patient body habitus and motion, deep lesion)
CEUSTo observe lesion microperfusion dynamicallyThe only US technique recommended for HCC diagnosis
Detect eHCC that invisible on B-mode US
Suitable for CT/MRI contradication
No renal toxicity		Few lesions can be characterized at one session
Lower sensitivity than CT/MRI
Confounding factors (respiration, lesion visualization and operator experience)
CEUS LI-RADSTo stratify the likelihood of HCC by imaging appearance on CEUS and lesion sizeHigh interobserver consistency in assessing APHE
High specificity for CEUS LR-5
The most widely applied CEUS reference for HCC diagnosis		Poor to moderate interobserver consistency in assessing washout
CEUS LR-3 reduces the HCC diagnostic probability
Poor sensitivity for CEUS LR-5
Current version not available for Sonazoid contrast agent
Super resolution USTo precisely localize and track microbubble for ultrahigh-resolution vascular imaging10 times better spatial resolution than CEUS
Wide flow velocity measurement range mm/s to cm/s and independent of Doppler angle		Slow imaging speeds
Susceptibility to probe or tissue motion
Fails to resolve the complete capillary bed
US elastographyTo detect tissue stiffness by measuring the elasticity coefficientGood reproducibility with same device
Accuracy for liver fibrosis staging
High liver stiffness is related to HCC occurrence		Overlap of stiffness value for benign and malignant lesions
Confounding factors (sampling bias, lesion depth, necroinflammation, congestion, manufacture)
US radiomicsTo extract imaging features from US images in a high throughput mannerDetect information unrecognizable to naked eye
Avoid interpretation subjectivity		Poor interpretability and generalization
Input data may vary from different device and operators
Lack of standardization
Intraoperative USTo provide high-resolution imaging by directly placing transducer on liver surfaceHigh sensitivity in detecting small lesions
High spatial resolution
High diagnostic accuracy
Unaffected by gas, ribs and other structures
Immediate imaging and interpretation		Operators need to be experienced
Some lesions remain difficult to visualize
Difficult to show the whole liver
US fusion imagingTo fuse and reconstruct US/CEUS image with previous cross-sectional images in real timeDetect invisible lesions on B-mode US or CEUS
High positioning accuracy
High technical success rate
Low complication rate		Operation complexity
Operator dependent
Not suitable for patient with anatomical abnormality
LI-RADS CEUS nonradiation TRA v2024To provide instructions for tumor viability evaluation after non-radiation locoregional therapyEvaluation based on both intralesional and perilesional contrast enhancement
Broader criteria for intralesional enhancement and stricter criteria are used for perilesional enhancement		LR-TR Nonviable does not imply complete pathologic response
Indications only include partial locoregional treatment
Limited current studies
[1] Chan SL , Sun HC , Xu Y , Zeng H , El-Serag HB , Lee JM , et al . The Lancet Commission on addressing the global hepatocellular carcinoma burden: comprehensive strategies from prevention to treatment. Lancet 2025; 406: 731-778.
doi: 10.1016/S0140-6736(25)01042-6
[2] Singal AG , Lampertico P , Nahon P . Epidemiology and surveillance for hepatocellular carcinoma: new trends. J Hepatol 2020; 72: 250-261.
doi: 10.1016/j.jhep.2019.08.025
[3] Reig M , Forner A , Rimola J , Ferrer-Fabrega J , Burrel M , Garcia-Criado A , et al . BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 2022; 76: 681-693.
doi: 10.1016/j.jhep.2021.11.018
[4] European Association for the Study of the Liver . EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2018; 69: 182-236.
doi: 10.1016/j.jhep.2018.03.019
[5] Marrero JA , Kulik LM , Sirlin CB , Zhu AX , Finn RS , Abecassis MM , et al . Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2018; 68: 723-750.
doi: 10.1002/hep.29913
[6] Xie DY , Zhu K , Ren ZG , Zhou J , Fan J , Gao Q . A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights. Hepatobiliary Surg Nutr 2023; 12: 216-228.
doi: 10.21037/hbsn-22-469
[7] Omata M , Cheng AL , Kokudo N , Kudo M , Lee JM , Jia J , et al . Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int 2017; 11: 317-370.
doi: 10.1007/s12072-017-9799-9
[8] Faccia M , Garcovich M , Ainora ME , Riccardi L , Pompili M , Gasbarrini A , et al . Contrast-enhanced ultrasound for monitoring treatment response in different stages of hepatocellular carcinoma. Cancers (Basel) 2022; 14: 481.
doi: 10.3390/cancers14030481
[9] Yang D , Chen X , Huang L , Wang X , Mao L , Lin L , et al . Correlation between CEUS LI-RADS categorization of HCC < 20 mm and clinic-pathological features. Insights Imaging 2024; 15: 110.
doi: 10.1186/s13244-024-01688-7
[10] Fan PL , Ding H , Mao F , Chen LL , Dong Y , Wang WP . Enhancement patterns of small hepatocellular carcinoma (</= 30 mm) on contrast-enhanced ultrasound: correlation with clinicopathologic characteristics. Eur J Radiol 2020; 132: 109341.
doi: 10.1016/j.ejrad.2020.109341
[11] European Association for the Study of the Liver . EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol 2025; 82: 315-374.
doi: 10.1016/j.jhep.2024.08.028
[12] Korean Liver Cancer Association, 2022 KLCA-NCC Korea Practice Guidelines for the management of hepatocellular carcinoma. Korean J Radiol 2022; 23:1126-1240.
[13] Kudo M , Kawamura Y , Hasegawa K , Tateishi R , Kariyama K , Shiina S , et al . Management of hepatocellular carcinoma in Japan: JSH consensus statements and recommendations 2021 update. Liver Cancer 2021; 10: 181-223.
doi: 10.1159/000514174
[14] Desjonqueres E , Campani C , Marra F , Zucman-Rossi J , Nault JC . Preneoplastic lesions in the liver: molecular insights and relevance for clinical practice. Liver Int 2022; 42: 492-506.
doi: 10.1111/liv.15152
[15] International Consensus Group for Hepatocellular Neoplasia . Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology 2009; 49: 658-664.
doi: 10.1002/hep.22709
[16] Kudo M . Early hepatocellular carcinoma: definition and diagnosis. Liver Cancer 2013; 2: 69-72.
doi: 10.1159/000343842
[17] Yang F , Zhao J , Liu C , Mao Y , Mu J , Wei X , et al . Superb microvascular imaging technique in depicting vascularity in focal liver lesions: more hypervascular supply patterns were depicted in hepatocellular carcinoma. Cancer Imaging 2019; 19: 92.
doi: 10.1186/s40644-019-0277-6
[18] Singal AG , Zhang E , Narasimman M , Rich NE , Waljee AK , Hoshida Y , et al . HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: a meta-analysis. J Hepatol 2022; 77: 128-139.
doi: 10.1016/j.jhep.2022.01.023
[19] Singal A , Volk ML , Waljee A , Salgia R , Higgins P , Rogers MA , et al . Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther 2009; 30: 37-47.
doi: 10.1111/j.1365-2036.2009.04014.x
[20] Tzartzeva K , Obi J , Rich NE , Parikh ND , Marrero JA , Yopp A , et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: a meta-analysis. Gastroenterology 2018; 154:1706-1718 e1701.
[21] Son JH , Choi SH , Kim SY , Jang HY , Byun JH , Won HJ , et al . Validation of US Liver Imaging Reporting and Data System version 2017 in patients at high risk for hepatocellular carcinoma. Radiology 2019; 292: 390-397.
doi: 10.1148/radiol.2019190035
[22] Park MK , Lee DH , Hur BY , Lee HC , Lee YB , Yu SJ , et al . Effectiveness of US surveillance of hepatocellular carcinoma in chronic hepatitis B: US LI-RADS visualization score. Radiology 2023; 307: e222106.
doi: 10.1148/radiol.222106
[23] Bae JS , Lee JM , Jeon SK , Jang S . Comparison of microFlow imaging with color and power Doppler imaging for detecting and characterizing blood flow signals in hepatocellular carcinoma. Ultrasonography 2020; 39: 85-93.
doi: 10.14366/usg.19033
[24] Dong Y , Wang WP , Ignee A , Zuo D , Qiu YJ , Zhang Q , et al . The diagnostic value of Doppler resistive index in the differential diagnosis of focal liver lesions. J Ultrason 2023; 23: e45-e52.
doi: 10.15557/JoU.2023.0010
[25] Kumada T , Nakano S , Toyoda H , Hayashi K , Kiriyama S , Sone Y , et al . Assessment of tumor hemodynamics in small hepatocellular carcinoma: comparison of Doppler ultrasonography, angiography-assisted computed tomography, and pathological findings. Liver Int 2004; 24: 425-431.
doi: 10.1111/j.1478-3231.2004.0932.x
[26] Dubinsky TJ , Revels J , Wang S , Toia G , Sonneborn R , Hippe DS , et al . Comparison of superb microvascular imaging with color flow and power Doppler imaging of small hepatocellular carcinomas. J Ultrasound Med 2018; 37: 2915-2924.
doi: 10.1002/jum.14654
[27] Cannella R , Pilato G , Mazzola M , Bartolotta TV . New microvascular ultrasound techniques: abdominal applications. Radiol Med 2023; 128: 1023-1034.
doi: 10.1007/s11547-023-01679-6
[28] Han H , Ji Z , Huang B , Mao L , Cao Q , Fan P , et al . The preliminary application of simultaneous display of contrast-enhanced ultrasound and micro-flow imaging technology in the diagnosis of hepatic tumors. J Ultrasound Med 2023; 42: 729-737.
doi: 10.1002/jum.16111
[29] Jeon SK , Lee JY , Han JK . Superb microvascular imaging technology of ultrasound examinations for the evaluation of tumor vascularity in hepatic hemangiomas. Ultrasonography. 2021; 40: 538-545.
doi: 10.14366/usg.20177
[30] Xu HX , Xie XY , Lu MD , Liu GJ , Xu ZF , Zheng YL , et al . Contrast-enhanced sonography in the diagnosis of small hepatocellular carcinoma < or = 2 cm. J Clin Ultrasound 2008; 36: 257-266.
doi: 10.1002/jcu.20433
[31] Zhang Z , Ma C , Luo Y . Diagnostic value of liver contrast-enhanced ultrasound in early hepatocellular carcinoma: a systematic review and meta-analysis. J Gastrointest Oncol 2023; 14: 626-635.
doi: 10.21037/jgo-23-211
[32] Duisyenbi Z , Numata K , Nihonmatsu H , Fukuda H , Chuma M , Kondo M , et al . Comparison between low mechanical index and high mechanical index contrast modes of contrast-enhanced ultrasonography: evaluation of perfusion defects of hypervascular hepatocellular carcinomas during the post-vascular phase. J Ultrasound Med 2019; 38: 2329-2338.
doi: 10.1002/jum.14926
[33] Iavarone M , Sangiovanni A , Forzenigo LV , Massironi S , Fraquelli M , Aghemo A , et al . Diagnosis of hepatocellular carcinoma in cirrhosis by dynamic contrast imaging: the importance of tumor cell differentiation. Hepatology 2010; 52: 1723-1730.
doi: 10.1002/hep.23903
[34] Forner A , Vilana R , Bianchi L , Rodriguez-Lope C , Reig M , Garcia-Criado MA , et al . Lack of arterial hypervascularity at contrast-enhanced ultrasound should not define the priority for diagnostic work-up of nodules < 2 cm. J Hepatol 2015; 62: 150-155.
doi: 10.1016/j.jhep.2014.08.028
[35] Kudo M , Ueshima K , Osaki Y , Hirooka M , Imai Y , Aso K , et al . B-Mode ultrasonography versus contrast-enhanced ultrasonography for surveillance of hepatocellular carcinoma: a prospective multicenter randomized controlled trial. Liver Cancer 2019; 8: 271-280.
doi: 10.1159/000501082
[36] Ren J , Lu Q , Fei X , Dong Y , D Onofrio M , Sidhu PS , et al . Assessment of arterial-phase hyperenhancement and late-phase washout of hepatocellular carcinoma-a meta-analysis of contrast-enhanced ultrasound (CEUS) with SonoVue(R) and Sonazoid(R). Eur Radiol 2024; 34: 3795-3812
[37] Goto E , Masuzaki R , Tateishi R , Kondo Y , Imamura J , Goto T , et al . Value of post-vascular phase (Kupffer imaging) by contrast-enhanced ultrasonography using Sonazoid in the detection of hepatocellular carcinoma. J Gastroenterol 2012; 47: 477-485.
doi: 10.1007/s00535-011-0512-9
[38] Sugimoto K , Moriyasu F , Saito K , Taira J , Saguchi T , Yoshimura N , et al . Comparison of Kupffer-phase Sonazoid-enhanced sonography and hepatobiliary-phase gadoxetic acid-enhanced magnetic resonance imaging of hepatocellular carcinoma and correlation with histologic grading. J Ultrasound Med 2012; 31: 529-538.
doi: 10.7863/jum.2012.31.4.529
[39] Ling W , Wang M , Ma X , Qiu T , Li J , Lu Q , et al . The preliminary application of liver imaging reporting and data system (LI-RADS) with contrast-enhanced ultrasound (CEUS) on small hepatic nodules (≤ 2 cm). J Cancer 2018; 9: 2946-2952.
doi: 10.7150/jca.25539
[40] Huang JY , Li JW , Lu Q , Luo Y , Lin L , Shi YJ , et al . Diagnostic accuracy of CEUS LI-RADS for the characterization of liver nodules 20 mm or smaller in patients at risk for hepatocellular carcinoma. Radiology 2020; 294: 329-339.
doi: 10.1148/radiol.2019191086
[41] Zheng W , Li Q , Zou XB , Wang JW , Han F , Li F , et al . Evaluation of contrast-enhanced US LI-RADS version 2017: application on 2020 liver nodules in patients with hepatitis B infection. Radiology 2020; 294: 299-307.
doi: 10.1148/radiol.2019190878
[42] Wu J , Zhao Q , Wang Y , Xiao F , Cai W , Liu S , et al . Feeding artery: a valuable feature for differentiation of regenerative nodule, dysplastic nodules and small hepatocellular carcinoma in CEUS LI-RADS. Eur Radiol 2024; 34: 745-754
[43] Takahashi H , Sugimoto K , Kamiyama N , Sakamaki K , Kakegawa T , Wada T , et al . Noninvasive diagnosis of hepatocellular carcinoma on Sonazoid-enhanced US: value of the kupffer phase. Diagnostics (Basel) 2022; 12: 141.
doi: 10.3390/diagnostics12010141
[44] Dencks S , Lowerison M , Hansen-Shearer J , Shin Y , Schmitz G , Song P , et al . Super-resolution ultrasound: from data acquisition and motion correction to localization, tracking, and evaluation. IEEE Trans Ultrason Ferroelectr Freq Control 2025; 72: 408-426.
doi: 10.1109/TUFFC.2025.3543322
[45] Hingot V , Errico C , Heiles B , Rahal L , Tanter M , Couture O . Microvascular flow dictates the compromise between spatial resolution and acquisition time in ultrasound localization microscopy. Sci Rep 2019; 9: 2456.
doi: 10.1038/s41598-018-38349-x
[46] Zeng QQ , An SZ , Chen CN , Wang Z , Liu JC , Wan MX , et al . Focal liver lesions: multiparametric microvasculature characterization via super-resolution ultrasound imaging. Eur Radiol Exp 2024; 8: 138.
doi: 10.1186/s41747-024-00540-3
[47] Wang F , Yu J , Lu X , Numata K , Ruan L , Zhang D , et al . Relationship between contrast-enhanced ultrasound combined with ultrasound resolution microscopy imaging and histological features of hepatocellular carcinoma. Abdom Radiol (NY) 2025; 50: 3530-3542.
doi: 10.1007/s00261-025-04825-y
[48] Jin YJ , Kim HY , Suh YJ , Lee CH , Yu JH , Kim MN , et al . Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using vibration-controlled transient elastography: systematic review and meta-analysis. Clin Mol Hepatol 2024; 30: S159-S171.
doi: 10.3350/cmh.2024.0163
[49] Li JW , Ling WW , Lu Q , Lu CL , He D , Luo Y . Liver stiffness and serum alpha-fetoprotein in discriminating small hepatocellular carcinoma from cirrhotic nodule. Ultrasound Q 2016; 32: 319-326.
doi: 10.1097/RUQ.0000000000000244
[50] Jiang D , Qian Y , Gu YJ , Wang R , Yu H , Dong H , et al . Predicting hepatocellular carcinoma: a new non-invasive model based on shear wave elastography. World J Gastroenterol 2024; 30: 3166-3178.
doi: 10.3748/wjg.v30.i25.3166
[51] Pierce TT , Ozturk A , Sherlock SP , Moura Cunha G , Wang X , Li Q , et al . Reproducibility and repeatability of US shear-wave and transient elastography in nonalcoholic fatty liver disease. Radiology 2024; 312: e233094.
doi: 10.1148/radiol.233094
[52] Yang Q , Wei J , Hao X , Kong D , Yu X , Jiang T , et al . Improving B-mode ultrasound diagnostic performance for focal liver lesions using deep learning: a multicentre study. EBioMedicine 2020; 56: 102777.
doi: 10.1016/j.ebiom.2020.102777
[53] Lu RF , She CY , He DN , Cheng MQ , Wang Y , Huang H , et al . AI enhanced diagnostic accuracy and workload reduction in hepatocellular carcinoma screening. NPJ Digit Med 2025; 8: 500.
doi: 10.1038/s41746-025-01892-9
[54] Du Z , Fan F , Ma J , Liu J , Yan X , Chen X , et al . Development and validation of an ultrasound-based interpretable machine learning model for the classification of ≤ 3 cm hepatocellular carcinoma: a multicentre retrospective diagnostic study. EClinicalMedicine 2025; 81: 103098.
doi: 10.1016/j.eclinm.2025.103098
[55] Ding W , Meng Y , Ma J , Pang C , Wu J , Tian J , et al . Contrast-enhanced ultrasound-based AI model for multi-classification of focal liver lesions. J Hepatol 2025; 83: 426-439.
doi: 10.1016/j.jhep.2025.01.011
[56] Xian MF , Lan WT , Zhang Z , Li MD , Lin XX , Huang Y , et al . Enhancing hepatocellular carcinoma diagnosis in non-high-risk patients: a customized ChatGPT model integrating contrast-enhanced ultrasound. Radiol Med 2025; 130: 1013-1023.
doi: 10.1007/s11547-025-01994-0
[57] Liu F , Liu D , Wang K , Xie X , Su L , Kuang M , et al . Deep learning radiomics based on contrast-enhanced ultrasound might optimize curative treatments for very-early or early-stage hepatocellular carcinoma patients. Liver Cancer 2020; 9: 397-413.
doi: 10.1159/000505694
[58] Wagnetz U , Atri M , Massey C , Wei AC , Metser U . Intraoperative ultrasound of the liver in primary and secondary hepatic malignancies: comparison with preoperative 1.5-T MRI and 64-MDCT. AJR Am J Roentgenol 2011; 196: 562-568.
doi: 10.2214/AJR.10.4729
[59] Takigawa Y , Sugawara Y , Yamamoto J , Shimada K , Yamasaki S , Kosuge T , et al . New lesions detected by intraoperative ultrasound during liver resection for hepatocellular carcinoma. Ultrasound Med Biol 2001; 27: 151-156.
doi: 10.1016/S0301-5629(00)00346-X
[60] Ahn JH , Eom DW , Ryu DS , Park MS , Jung SM , Choi KM , et al . Synchronous multicentric small hepatocellular carcinomas: defining the capsule on high-frequency intraoperative ultrasonography with pathologic correlation. Ultrasonography 2016; 35: 335-344.
doi: 10.14366/usg.16001
[61] Iancu I , Bartos A , Cioltean C , Branzila S , Bocse H , Herdean A , et al . Up to date and perspectives for hepatocellular carcinoma\'s intraoperative ultrasound. Chirurgia (Bucur) 2021; 116: 399-408.
doi: 10.21614/chirurgia.116.4.399
[62] Wu W , Jing X , Xue GQ , Zhu XL , Wang J , Du RQ , et al . A multicenter randomized controlled study of contrast-enhanced US versus US-guided biopsy of focal liver lesions. Radiology 2022; 305: 721-728.
doi: 10.1148/radiol.212317
[63] Peloso A , Franchi E , Canepa MC , Barbieri L , Briani L , Ferrario J , et al . Combined use of intraoperative ultrasound and indocyanine green fluorescence imaging to detect liver metastases from colorectal cancer. HPB (Oxford) 2013; 15: 928-934.
doi: 10.1111/hpb.12057
[64] Omichi K , Inoue Y , Hasegawa K , Sakamoto Y , Okinaga H , Aoki T , et al . Differential diagnosis of liver tumours using intraoperative real-time tissue elastography. Br J Surg 2015; 102: 246-253.
doi: 10.1002/bjs.9728
[65] da Silva NPB , Hornung M , Beyer LP , Hackl C , Brunner S , Schlitt HJ , et al . Intraoperative shear wave elastography vs. contrast-enhanced ultrasound for the characterization and differentiation of focal liver lesions to optimize liver tumor surgery. Ultraschall Med 2019; 40: 205-211
[66] European Society of Radiology . Abdominal applications of ultrasound fusion imaging technique: liver, kidney, and pancreas. Insights Imaging 2019; 10: 6.
doi: 10.1186/s13244-019-0692-z
[67] Zhou Y , Wang Y , Wang F , Zhang X , Ding J , Zhou H , et al . Additional diagnostic value of fusion imaging of CEUS and first CEUS of invisible hepatic lesions ≤ 2 cm. J Ultrasound Med 2021; 40: 1173-1181.
doi: 10.1002/jum.15498
[68] Calandri M , Mauri G , Yevich S , Gazzera C , Basile D , Gatti M , et al . Fusion imaging and virtual navigation to guide percutaneous thermal ablation of hepatocellular carcinoma: a review of the literature. Cardiovasc Intervent Radiol 2019; 42: 639-647.
doi: 10.1007/s00270-019-02167-z
[69] Huang Q , Zeng Q , Long Y , Tan L , Zheng R , Xu E , et al . Fusion imaging techniques and contrast-enhanced ultrasound for thermal ablation of hepatocellular carcinoma - a prospective randomized controlled trial. Int J Hyperthermia 2019; 36: 1207-1215
[70] Melendez-Torres J , Singal AG . Early detection of hepatocellular carcinoma: roadmap for improvement. Expert Rev Anticancer Ther 2022; 22: 621-632.
doi: 10.1080/14737140.2022.2074404
[71] Huang H , Cheng MQ , He DN , Xian MF , Zeng D , Wu SH , et al . US LI-RADS in surveillance for recurrent hepatocellular carcinoma after curative treatment. Eur Radiol 2023; 33: 9357-9367.
doi: 10.1007/s00330-023-09903-7
[72] Hong SK , Jin XL , Suh S , Hong SY , Hong K , Han ES , et al . Different risk factors for early and late recurrence after curative resection of hepatocellular carcinoma. World J Surg 2022; 46: 197-206.
doi: 10.1007/s00268-021-06308-9
[73] Hai Y , Savsani E , Chong W , Eisenbrey J , Lyshchik A . Meta-analysis and systematic review of contrast-enhanced ultrasound in evaluating the treatment response after locoregional therapy of hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46: 5162-5179.
doi: 10.1007/s00261-021-03248-9
[74] Lyshchik A , Fetzer DT , Kono Y , Wilson SR , Dietrich CF , Clevert DA , et al . Liver Imaging Reporting and Data System Contrast-Enhanced US Nonradiation Treatment Response Assessment version 2024. Radiology 2024; 311: e232369.
doi: 10.1148/radiol.232369
[75] Deng H , Shang W , Wang K , Guo K , Liu Y , Tian J , et al . Targeted-detection and sequential-treatment of small hepatocellular carcinoma in the complex liver environment by GPC-3-targeted nanoparticles. J Nanobiotechnology 2022; 20: 156.
doi: 10.1186/s12951-022-01378-w
[76] Qi S , Liu G , Chen J , Cao P , Lei X , Ding C , et al . Targeted multifunctional nanoplatform for imaging-guided precision diagnosis and photothermal/photodynamic therapy of orthotopic hepatocellular carcinoma. Int J Nanomedicine 2022; 17: 3777-3792
[77] Baron Toaldo M , Salvatore V , Marinelli S , Palama C , Milazzo M , Croci L , et al . Use of VEGFR-2 targeted ultrasound contrast agent for the early evaluation of response to sorafenib in a mouse model of hepatocellular carcinoma. Mol Imaging Biol 2015; 17: 29-37.
doi: 10.1007/s11307-014-0764-x
[78] Zhang C , Zhang Q , Xu Q , Jiang X , Ma Y , Liu C , et al . Ultrasound targeted microbubbles for theranostic applications in liver diseases: from molecular imaging to targeted therapy. Drug Deliv 2025; 32: 2541656.
doi: 10.1080/10717544.2025.2541656
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