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Minami et al. Hepatoma Res 2020;6:46 Hepatoma Research
DOI: 10.20517/2394-5079.2020.32

Review Open Access

Contrast-enhanced ultrasonography with Sonazoid
in hepatocellular carcinoma diagnosis

Yasunori Minami, Masatoshi Kudo

Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan.
Correspondence to: Prof. Yasunori Minami, Department of Gastroenterology and Hepatology, Kindai University Faculty of
Medicine, 377-2 Ohno-higashi Osaka-sayama, Osaka 589-8511, Japan. E-mail: minkun@med.kindai.ac.jp

How to cite this article: Minami Y, Kudo M. Contrast-enhanced ultrasonography with sonazoid in hepatocellular carcinoma
diagnosis. Hepatoma Res 2020;6:46. http://dx.doi.org/10.20517/2394-5079.2020.32

Received: 25 Mar 2020 First Decision: 11 May 2020 Revised: 12 May 2020 Accepted: 23 Jun 2020 Published: 7 Aug 2020
Academic Editor: Yuko Kono Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
With the development of second-generation contrast agents and advancement in contrast harmonic imaging,
contrast-enhanced ultrasonography (CEUS) now has the capacity to sensitively and accurately show tumor
vascularity. Therefore, marked improvements have been achieved in the diagnosis of focal liver lesions(FLLs),
including hepatocellular carcinoma (HCC), by US. In contrast to other agents, Kupffer cells in liver sinusoids take
up Sonazoid. Two contrast enhancement phases occur in CEUS with Sonazoid: a vascular phase and Kupffer
phase. Images obtained in the Kupffer phase have higher diagnostic sensitivity for hepatic malignancies because
the majority of these malignancies do not contain Kupffer cells. Dynamic images obtained in the vascular phase
markedly narrow the clinical differential diagnoses of FLLs. The sustainable detection of inconspicuous HCC,
adequate guidance of ablation therapy, and accurate assessment of treatment responses in HCC are all facilitated
by Sonazoid. The principles, clinical applications, and techniques of CEUS with Sonazoid in the diagnosis of HCC
will be reviewed herein.

Keywords: Contrast-enhanced ultrasonography, focal liver lesion, hepatocellular carcinoma, sonazoid

INTRODUCTION
Recent advances in the multi-modality treatment of hepatocellular carcinoma (HCC) have contributed to
significant improvement in the prognosis of patients with this type of primary liver cancer. The importance
of the early detection of liver nodules, accurate diagnosis of HCC, and tumor staging for treatment planning
is increasingly recognized. Guidelines for the utilization of imaging tests in the diagnosis of HCC have been
developed by a number of societies, including the American Association for the Study of Liver Diseases
(AASLD), the European Association for the Study of the Liver, the Asian-Pacific Association for the Study
[1-4]
of Liver, and the Japan Society of Hepatology . Due to advances in techniques that have contributed to the
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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