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Minami et al. Hepatoma Res 2020;6:46 I http://dx.doi.org/10.20517/2394-5079.2020.32 Page 9 of 11

Sorafenib (Bayer, Leverkusen, Germany) is the first oral multikinase inhibitor developed for advanced
unresectable HCC. Analyses of time intensity curves and arrival time parametric imaging facilitated
assessments of the early responses of advanced HCC to sorafenib [51,52] . However, not all lesions of multiple
HCC treated with sorafenib exhibit similar behaviors on CEUS; therefore, CEUS may only investigate a
few regions of interest and may be limited to treatment response assessments of multiple HCC to systemic
chemotherapies.

CONCLUSION
US is a widely used imaging modality for liver diseases because it is minimally invasive, allows for real-
time observations, and provides high-resolution images. However, the accuracy of CEUS may be negatively
affected by a number of factors, such as acoustic attenuation, various artifacts, and blind areas. Therefore,
the favorable and unfavorable characteristics of CEUS need to be carefully considered. This review
comprehensively demonstrates the importance of CEUS with Sonazoid for managing patients with HCC.
CEUS provides real-time and high-quality images of FLLs, including HCC, in all phases of enhancement,
and has markedly increased the accuracy of US-based detection and characterization. CEUS has the ability
to differentiate between benign and malignant liver nodules with high accuracy, which is crucial in the
management of these patients. Furthermore, CEUS with Sonazoid provides guidance during therapeutic
procedures and facilitates assessments of treatment responses. The adequate guidance of ablation and precise
monitoring of treatment responses using CEUS with Sonazoid will contribute to further improvement in the
prognosis of patients with HCC.

DECLARATIONS
Authors’ contributions
Study concepts/study design, data acquisition and manuscript drafting: Minami Y
Manuscript editing: Kudo M

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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