From the Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, Canada T2N 2T9 (S.B., J.G., C.M., J.K.W., S.R.W.); and Departments of Medicine, Division of Gastroenterology and Hepatology (K.W.B., S.R.W.), and Radiology (J.K.W., S.R.W.), University of Calgary, Calgary, Alberta, Canada.
Radiographics. 2019 Sep-Oct;39(5):1302-1322. doi: 10.1148/rg.2019180205. Epub 2019 Jul 26.
Hepatocellular carcinoma (HCC) has a high incidence of recurrence following therapy. Therefore, secondary surveillance (scheduled follow-up imaging after treatment) is an important part of disease management. The recent approval in the United States for use of a microbubble-based contrast agent for US liver imaging promotes the increased use of contrast-enhanced US (CEUS) in patients with HCC. Although the criteria for the diagnosis of HCC at CEUS are well described, there is a paucity of published literature describing the role of CEUS in ablative therapy and secondary surveillance. In the setting of ablative therapy, CEUS can have vital roles, including patient selection, intraprocedural guidance, and immediate postprocedural assessment. Although CEUS is not widely used, the authors found that it can be used to accurately detect residual or recurrent tumor, characterize the geographic pattern of recurrence (intrazonal, extrazonal, segmental, or remote), and assess for tumor in vein. In addition, similar to primary surveillance, secondary surveillance includes assessment of the entire liver for evaluation of new nodules. Arterial phase hyperenhancement is the reference standard characteristic of disease recurrence at secondary surveillance with CEUS. RSNA, 2019 See discussion on this article by Rodgers.
肝细胞癌 (HCC) 在治疗后复发率很高。因此，二次监测（治疗后定期随访成像）是疾病管理的重要组成部分。美国最近批准使用基于微泡的对比剂进行肝脏超声检查，这促进了 HCC 患者中对比增强超声 (CEUS) 的更多应用。尽管 CEUS 诊断 HCC 的标准已有详细描述，但关于 CEUS 在消融治疗和二次监测中的作用的文献却很少。在消融治疗中，CEUS 可以发挥重要作用，包括患者选择、术中引导和即刻术后评估。尽管 CEUS 尚未广泛应用，但作者发现它可用于准确检测残留或复发性肿瘤，对肿瘤的地理分布模式（肝内、肝外、节段性或远处）进行特征描述，并评估肿瘤在静脉中的情况。此外，与原发性监测相似，二次监测包括评估整个肝脏以评估新结节。CEUS 中动脉期高增强是疾病复发的参考标准特征。RSNA，2019 请参阅 Rodgers 对本文的讨论。
