Contrast-Enhanced Ultrasound in the Diagnosis, Treatment and Surveillance of Hepatocellular Carcinoma

Dear Colleagues,

Hepatocellular carcinoma (HCC) has faced many challenges in recent decades regarding epidemiology, diagnosis, and treatment options. Both the incidence and mortality rates of hepatocellular carcinoma (HCC) have risen dramatically since 1997, meaning that they are now secondary to nonalcoholic steatohepatitis in Western countries.

Noninvasive diagnosis procedures have continuously been in development; nowadays, the diagnosis of HCC on cirrhotic liver relies on a specific vascular pattern depicted on at least two imaging techniques, such as contrast-enhanced ultrasound (CEUS), computed tomography, and/or magnetic resonance. HCC can be diagnosed noninvasively with CEUS in cirrhosis if the characteristic pattern of arterial phase hyperenhancement, followed by hypoenhancement, is present. Among the different imaging modalities, CEUS has been applied for more than two decades and plays an increasingly important role in the management of HCC. Since early 2000, all international societies dedicated to liver diseases have highlighted the important role played by CEUS in the diagnosis of HCC.

An important aspect of this Special Issue is differential diagnoses with other tumors (like adenoma or cholangiocarcinoma) developed both on noncirrhotic and cirrhotic liver. In the context of increasing the prevalence of metabolic-associated fatty liver disease (MAFLD), HCC on steatosis liver is detected more frequently without cirrhosis.

Also, the therapeutic strategies in HCC have been continuously developed in recent decades regarding both ablative techniques and systemic therapies. The response after ablative treatments, like transarterial chemoembolization or radiofrequency ablation, benefits from CEUS. Of all the available imaging modalities, CEUS performs better in the early and very early assessment of TACE, especially after lipiodol TACE. CEUS also proved to be a reliable procedure for the immediate assessment of radiofrequency ablation efficacy. Dynamic CEUS (D-CEUS) has emerged as a promising tool for depicting changes in tumor perfusion during antiangiogenetic treatment, which can be associated with tumor response and clinical outcome.

This Special Issue of Cancers is dedicated to CEUS in HCC, aiming to encourage discussions regarding all the challenges faced by clinicians and the presentation of research on how to manage all the stages of HCC, from diagnosis to treatment and surveillance. We also encourage the submission of papers regarding differential diagnosis with other tumors developed both on cirrhotic and noncirrhotic liver (MAFLD), focusing on imaging aspects and vascular patterns.

Prof. Dr. Radu Ion Badea
Dr. Lidia Ciobanu
Guest Editors

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• CEUS
• HCC
• dysplastic nodules
• TACE efficacy assessment
• radio-ablative techniques assessment
• dynamic CEUS
• surveillance