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Volume 42 Issue 7
Jul.  2026
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Article Navigation >  Journal of Clinical Hepatology  > 2026  >  42(7): 1501-1506

Strategies for the application of ultrasound in early and differential diagnosis of hepatocellular carcinoma

DOI: 10.12449/JCH260703

  • Department of Ultrasound，The First Medical Center of Chinese PLA General Hospital，Beijing 100853，China

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  • Corresponding author: Luo Yukun， lyk301@163.com （ORCID： 0000-0002-5944-8198）
  • Received Date: 2026-04-30
  • Accepted Date: 2026-07-03
  • Published Date: 2026-07-25
    Abstract
  • Hepatocellular carcinoma （HCC） often has an insidious onset， and early diagnosis and accurate differential diagnosis are critical for improving the prognosis of patients. Ultrasound remains an important radiological examination for the screening and initial assessment of high-risk populations due to its advantages of convenience， real-time monitoring， repeatability， and suitability for dynamic follow-up. With the development of ultrasound technologies in recent years， the application of ultrasound in HCC has gradually expanded from lesion detection to lesion characterization， differential diagnosis， and prognostic evaluation. With reference to the clinical needs for the early and differential diagnosis of HCC， this article reviews the application value， clinical localization， and limitations of gray-scale ultrasound， Doppler ultrasound， and contrast-enhanced ultrasound in HCC， with a focus on their application in the evaluation and differential diagnosis of small HCC. It highlights that comprehensive evaluation should be performed based on liver background， lesion morphology， blood flow features， enhancement patterns， and dynamic changes during follow-up， so as to improve the early and differential diagnosis of HCC.

     

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    • References(38)
  • [1]
    Wang W Y, Wei C. Advances in the early diagnosis of hepatocellular carcinoma[J]. Genes Dis, 2020, 7( 3): 308- 319. DOI: 10.1016/j.gendis.2020.01.014.
    [2]
    Singal A G, Zhang E, Narasimman M, et al. HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: A meta-analysis[J]. J Hepatol, 2022, 77( 1): 128- 139. DOI: 10.1016/j.jhep.2022.01.023.
    [3]
    National Health Commission of the People’s Republic of China. Guideline for diagnosis and treatment of primary liver cancer(2026 edition)[J]. J Clin Hepatol, 2026, 42( 4): 794- 827. DOI: 10.12449/JCH260409.

    中华人民共和国国家卫生健康委员会. 原发性肝癌诊疗指南(2026年版)[J]. 临床肝胆病杂志, 2026, 42( 4): 794- 827. DOI: 10.12449/JCH260409.
    [4]
    European Association for the Study of the Liver. EASL clinical practice guidelines on the management of hepatocellular carcinoma[J]. J Hepatol, 2025, 82( 2): 315- 374. DOI: 10.1016/j.jhep.2024.08.028.
    [5]
    Singal A G, Llovet J M, Yarchoan M, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma[J]. Hepatology, 2023, 78( 6): 1922- 1965. DOI: 10.1097/HEP.0000000000000466.
    [6]
    Lau G, Obi S, Zhou J, et al. APASL clinical practice guidelines on systemic therapy for hepatocellular carcinoma-2024[J]. Hepatol Int, 2024, 18( 6): 1661- 1683. DOI: 10.1007/s12072-024-10732-z.
    [7]
    Tzartzeva K, Obi J, Rich N E, et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: A meta-analysis[J]. Gastroenterology, 2018, 154( 6): 1706- 1718.e1. DOI: 10.1053/j.gastro.2018.01.064.
    [8]
    Kim D H, Hong S B, Choi S H, et al. Surveillance failure in ultrasound for hepatocellular carcinoma: A systematic review and meta-analysis[J]. Gut, 2022, 71( 1): 212- 213. DOI: 10.1136/gutjnl-2020-323615.
    [9]
    Barnard Giustini A, Ioannou G N, Sirlin C, et al. Review article: Available modalities for screening and imaging diagnosis of hepatocellular carcinoma-Current gaps and challenges[J]. Aliment Pharmacol Ther, 2023, 57( 10): 1056- 1065. DOI: 10.1111/apt.17506.
    [10]
    Huang D Q, Singal A G, Kanwal F, et al. Hepatocellular carcinoma surveillance: Utilization, barriers and the impact of changing aetiology[J]. Nat Rev Gastroenterol Hepatol, 2023, 20( 12): 797- 809. DOI: 10.1038/s41575-023-00818-8.
    [11]
    Schoenberger H, Chong N, Fetzer D T, et al. Dynamic changes in ultrasound quality for hepatocellular carcinoma screening in patients with cirrhosis[J]. Clin Gastroenterol Hepatol, 2022, 20( 7): 1561- 1569.e4. DOI: 10.1016/j.cgh.2021.06.012.
    [12]
    Park J, Lee J M, Kim T H, et al. Imaging diagnosis of hepatocellular carcinoma: Future directions with special emphasis on hepatobiliary magnetic resonance imaging and contrast-enhanced ultrasound[J]. Clin Mol Hepatol, 2022, 28( 3): 362- 379. DOI: 10.3350/cmh.2021.0361.
    [13]
    Koo E, Seif El Dahan K, Daher D, et al. Risk of hepatocellular carcinoma in subcentimeter liver nodules identified on surveillance ultrasound: A systematic review[J]. Clin Gastroenterol Hepatol, 2025, 23( 8): 1320- 1327.e2. DOI: 10.1016/j.cgh.2024.08.051.
    [14]
    Choi S J, Choi S H, Kim D W, et al. Value of threshold growth as a major diagnostic feature of hepatocellular carcinoma in LI-RADS[J]. J Hepatol, 2023, 78( 3): 596- 603. DOI: 10.1016/j.jhep.2022.11.006.
    [15]
    Vogel A, Meyer T, Sapisochin G, et al. Hepatocellular carcinoma[J]. Lancet, 2022, 400( 10360): 1345- 1362. DOI: 10.1016/S0140-6736(22)01200-4.
    [16]
    Tanaka H. Current role of ultrasound in the diagnosis of hepatocellular carcinoma[J]. J Med Ultrason(2001), 2020, 47( 2): 239- 255. DOI: 10.1007/s10396-020-01012-y.
    [17]
    Lencioni R, Piscaglia F, Bolondi L. Contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma[J]. J Hepatol, 2008, 48( 5): 848- 857. DOI: 10.1016/j.jhep.2008.02.005.
    [18]
    Wilson A, Lim A K P. Microvascular imaging: New Doppler technology for assessing focal liver lesions. Is it useful?[J]. Clin Radiol, 2022, 77( 12): e807- e820. DOI: 10.1016/j.crad.2022.05.032.
    [19]
    Park M K, Lee D H, Hur B Y, et al. Effectiveness of US surveillance of hepatocellular carcinoma in chronic hepatitis B: US LI-RADS visualization score[J]. Radiology, 2023, 307( 5): e222106. DOI: 10.1148/radiol.222106.
    [20]
    Frinking P, Segers T, Luan Y, et al. Three decades of ultrasound contrast agents: A review of the past, present and future improvements[J]. Ultrasound Med Biol, 2020, 46( 4): 892- 908. DOI: 10.1016/j.ultrasmedbio.2019.12.008.
    [21]
    Zhou J H, Li L L, Yan K, et al. Expert consensus regarding the clinical application of liver contrast-enhanced US with Sonazoid(Sonazoid CEUS)[J]. Int J Surg, 2026, 112( 1): 55- 70. DOI: 10.1097/JS9.0000000000003510.
    [22]
    Terzi E, Iavarone M, Pompili M, et al. Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1, 006 nodules[J]. J Hepatol, 2018, 68( 3): 485- 492. DOI: 10.1016/j.jhep.2017.11.007.
    [23]
    Li L L, Dioguardi Burgio M, Fetzer D T, et al. Contrast-enhanced ultrasound for hepatocellular carcinoma diagnosis-AJR expert panel narrative review[J]. AJR Am J Roentgenol, 2026, 226( 2): e2532813. DOI: 10.2214/AJR.25.32813.
    [24]
    Korean Liver Cancer Association KLCA and National Cancer Center NCC Korea. 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma[J]. Clin Mol Hepatol, 2022, 28( 4): 583- 705. DOI: 10.3350/cmh.2022.0294.
    [25]
    Kudo M. Defect reperfusion imaging with sonazoid®: A breakthrough in hepatocellular carcinoma[J]. Liver Cancer, 2016, 5( 1): 1- 7. DOI: 10.1159/000367760.
    [26]
    American College of Radiology. CEUS LI-RADS 2017 Core[EB/OL]. https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS. https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/LI-RADS
    [27]
    Huang J Y, Li J W, Lu Q, et al. Diagnostic accuracy of CEUS LI-RADS for the characterization of liver nodules 20 mm or smaller in patients at risk for hepatocellular carcinoma[J]. Radiology, 2020, 294( 2): 329- 339. DOI: 10.1148/radiol.2019191086.
    [28]
    Pan J M, Chen W, Zheng Y L, et al. Tumor size-based validation of contrast-enhanced ultrasound liver imaging reporting and data system(CEUS LI-RADS) 2017 for hepatocellular carcinoma characterizing[J]. Br J Radiol, 2021, 94( 1126): 20201359. DOI: 10.1259/bjr.20201359.
    [29]
    Li Jiawu, Ling Wenwu, Chen Shuang, et al. Influence of liver lesion size and differentiation degree of hepatocellular carcinoma on classification of contrast-enhanced ultrasound liver imaging reporting and data management system[J]. Chin J Med Imaging Technol, 2022, 38( 9): 1356- 1360. DOI: 10.13929/j.issn.1003-3289.2022.09.017.

    李加伍, 凌文武, 陈爽, 等. 肝脏病灶大小及肝细胞癌分化程度对超声造影肝脏影像报告与数据管理系统分类诊断的影响[J]. 中国医学影像技术, 2022, 38( 9): 1356- 1360. DOI: 10.13929/j.issn.1003-3289.2022.09.017.
    [30]
    Yang D H, Chen X J, Huang L J, et al. Correlation between CEUS LI-RADS categorization of HCC < 20 mm and clinic-pathological features[J]. Insights Imaging, 2024, 15( 1): 110. DOI: 10.1186/s13244-024-01688-7.
    [31]
    Wu J P, Zhao Q X, Wang Y L, et al. Feeding artery: A valuable feature for differentiation of regenerative nodule, dysplastic nodules and small hepatocellular carcinoma in CEUS LI-RADS[J]. Eur Radiol, 2024, 34( 2): 745- 754. DOI: 10.1007/s00330-023-10006-6.
    [32]
    Li Y, Lu S L, Mao S Y, et al. Contrast-enhanced US using perfluorobutane for diagnosing small HCC in high-risk patients: Comparison with MRI LI-RADS version 2018[J]. Radiology, 2026, 318( 3): e252271. DOI: 10.1148/radiol.252271.
    [33]
    Lin M X, Lu D S, Duan Y, et al. Cirrhotic nodule transformation to hepatocellular carcinoma: Natural history and predictive biomarkers on contrast-enhanced ultrasound[J]. AJR Am J Roentgenol, 2020, 214( 1): 96- 104. DOI: 10.2214/AJR.19.21739.
    [34]
    D’Onofrio M, Crosara S, de Robertis R, et al. Contrast-enhanced ultrasound of focal liver lesions[J]. AJR Am J Roentgenol, 2015, 205( 1): W56- W66. DOI: 10.2214/AJR.14.14203.
    [35]
    Reizine E, Mulé S, Luciani A. Focal benign liver lesions and their diagnostic pitfalls[J]. Radiol Clin North Am, 2022, 60( 5): 755- 773. DOI: 10.1016/j.rcl.2022.05.005.
    [36]
    Liu G J, Wang W, Lu M D, et al. Contrast-enhanced ultrasound for the characterization of hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Liver Cancer, 2015, 4( 4): 241- 252. DOI: 10.1159/000367738.
    [37]
    Dong Y, Teufel A, Trojan J, et al. Contrast enhanced ultrasound in mixed hepatocellular cholangiocarcinoma: Case series and review of the literature[J]. Dig Liver Dis, 2018, 50( 4): 401- 407. DOI: 10.1016/j.dld.2017.11.003.
    [38]
    Dong Y, Zhang X L, Mao F, et al. Contrast-enhanced ultrasound features of histologically proven small(≤20 mm) liver metastases[J]. Scand J Gastroenterol, 2017, 52( 1): 23- 28. DOI: 10.1080/00365521.2016.1224380.
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