From the Departments of Radiology (M.M.L.) and Internal Medicine (N.D.P.), University of Michigan, Ann Arbor, Mich; Department of Radiology (D.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.G.S.), University of Texas Southwestern Medical Center, 5959 Harry Hines Blvd, Ste 420, POB 1, Dallas, TX 75390-8887; and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K.).
Radiology. 2024 May;311(2):e232624. doi: 10.1148/radiol.232624.
Abdominal US is currently the best-validated surveillance strategy for hepatocellular carcinoma (HCC) in at-risk patients. It is the only modality shown to have completed all five phases of validation and can achieve high sensitivity and specificity for HCC detection, especially when conducted by expert sonographers in high-volume centers. However, US also has limitations, including operator dependency and varying sensitivity in clinical practice. Further, the sensitivity of US for early-stage HCC detection is lower in patients with obesity or nonviral liver disease, increasingly common populations undergoing surveillance. Imaging-based and blood-based surveillance strategies, including abbreviated MRI and biomarker panels, may overcome some limitations of US-based surveillance. Both strategies have promising test performance in phase II and phase III biomarker studies and are undergoing prospective validation. Considering the variation in HCC risk and test performance between patients, there will likely be a shift away from a one-size-fits-all approach and toward precision screening, in which the "best" test is selected based on individual patient characteristics. In this upcoming era of precision HCC screening among patients with cirrhosis, US will likely continue to have an important, albeit reduced, surveillance role.
腹部超声检查是目前高危人群肝细胞癌（HCC）的最佳验证性监测策略。它是唯一一种被证明已完成验证所有五个阶段的方法，可实现 HCC 检测的高灵敏度和特异性，尤其是在大容量中心由专家超声医师进行检查时。然而，超声也存在局限性，包括操作人员依赖性和临床实践中的敏感性差异。此外，在肥胖或非病毒性肝病患者中，超声检测早期 HCC 的敏感性较低，而这些患者是越来越常见的正在接受监测的人群。基于影像学和基于血液的监测策略，包括缩短的 MRI 和生物标志物检测，可能会克服基于超声监测的一些局限性。这两种策略在 II 期和 III 期生物标志物研究中均具有良好的测试性能，正在进行前瞻性验证。考虑到 HCC 风险和检测性能在患者之间的差异，可能会从一刀切的方法向精准筛查转变，根据患者的个体特征选择“最佳”检测方法。在即将到来的肝硬化患者精准 HCC 筛查时代，超声可能仍将在监测方面发挥重要作用，尽管作用会有所降低。
