Current status of image-based surveillance in hepatocellular carcinoma

Abstract

Although the overall prognosis of patients with hepatocellular carcinoma (HCC) remains poor, curative treatment may improve the survival of patients diagnosed at an early stage through surveillance. Accordingly, ultrasonography (US)-based HCC surveillance programs proposed in international society guidelines are now being implemented and regularly updated based on the latest evidence to improve their efficacy. Recently, other imaging modalities such as magnetic resonance imaging have shown potential as alternative surveillance tools based on individualized risk stratification. In this review article, we describe the current status of US-based surveillance for HCC and summarize the supporting evidence. We also discuss alternative surveillance imaging modalities that are currently being studied to validate their diagnostic performance and cost-effectiveness.

Repeating Ultrasound for Hepatocellular Carcinoma Detection in Case of Inadequate Liver Visualization: A Matter of Expertise

“…Q2 liver ultrasound (US) is the standard surveillance modality of patients at risk of hepatocellular carcinoma (HCC) development and is endorsed by all international guidelines. 1 Nevertheless, despite its high accessibility and acceptability, the sensitivity of US to detect early stage tumors is suboptimal, 2 leading to surveillance failure and impaired survival. Several factors can explain these disappointing results; they can be related to the patient (male gender, overweight, bowel gas), underlying liver disease (alcohol-related liver disease, liver heterogeneity, impaired liver function), or the pattern of the lesion itself (size, margins, echogenicity, location).…”

Role of Ultrasound Methods for the Assessment of NAFLD

“…The likelihood of inadequate ultrasound quality is significantly higher in overweight or obese patients [ 57 ]. Furthermore, tumor-related factors, such as subcapsular location, small size, and infiltrative tumor type, can significantly impair the sensitivity of ultrasound [ 58 ]. In this context, another important issue is the quality of the ultrasound equipment and the experience of the examiner.…”

Hepatocellular Carcinoma in Non-Alcoholic Fatty Liver Disease: From Epidemiology to Diagnostic Approach

“…In addition to this, 20% of US examinations for patients with cirrhosis are of inadequate quality to rule out the presence of HCC, mostly due to US artifacts, inadequate US penetration and patient-related characteristics, such as obesity, Child B/C cirrhosis and alcohol or NASH related cirrhosis. Furthermore, there are some areas of the liver that are unreliable for US examination, such as the subcapsular regions [ 134 ]. In this context, another important issue is the quality of the US equipment and the experience of the ultrasonographer [ 133 ].…”