Contrast-Enhanced Ultrasound for Hepatocellular Carcinoma Diagnosis- Expert Panel Narrative Review.

Despite growing clinical use of contrast-enhanced ultrasound (CEUS), inconsistency remains in the modality's role in clinical pathways for hepatocellular carcinoma (HCC) diagnosis and management. This Expert Panel Narrative Review provides practical insights on the use of CEUS for the diagnosis of HCC across populations, including individuals at high risk for HCC, individuals with metabolic dysfunction-associated steatotic liver disease, and individuals not at high risk for HCC. Considerations addressed with respect to high-risk patients include CEUS diagnostic criteria for HCC, use of CEUS for differentiating HCC from non-HCC malignancy, use of CEUS for small (≤ 2 cm) lesions, use of CEUS for characterizing occult lesions on B-mode ultrasound, and use of CEUS for indeterminate lesions on CT or MRI. Representative literature addressing the use of CEUS for HCC diagnosis and gaps in knowledge requiring further investigation are highlighted. Throughout these discussions, the article distinguishes two broad types of ultrasound contrast agents used for liver imaging: pure blood-pool agents and a combined blood-pool and Kupffer-cell agent. Additional topics include the use of CEUS for treatment response assessment after nonradiation therapies and implications of artificial intelligence technologies. The article concludes with a series of consensus statements from the author panel.