Application of contrast-enhanced ultrasound in the full-course management of precise locoregional diagnosis and treatment for hepatocellular carcinoma

Hepatocellular carcinoma （HCC） is one of the major malignancies with the heaviest disease burden in China. Many patients have lost the opportunity for radical surgical resection at the time of diagnosis， with locoregional interventional therapy playing an increasingly important role in full-course HCC management. Contrast-enhanced ultrasound （CEUS） enables real-time dynamic assessment of tumor microvascular perfusion and has several practical advantages including bedside availability， no ionizing radiation， and repeatability， and its role has therefore expanded from an adjunctive diagnostic method to the full-course management of precise locoregional diagnosis and treatment for HCC. Before treatment， CEUS can assist in the qualitative diagnosis of lesions， lesion localization， delineation of the viable tumor， and planning of the puncture route， especially for lesions that are poorly visualized on conventional ultrasound. During and after treatment， CEUS can help to detect residual viable tumor， related complications， and local tumor progression， thereby providing a basis for additional ablation， transcatheter arterial chemoembolization， or adjustment of combined treatment strategies. In recent years， the CEUS LI-RADS treatment response assessment system has provided a standardized framework for evaluating response after locoregional therapy， and in addition， the development of unimodal and multimodal fusion imaging techniques has further promoted the standardized application of CEUS in precise locoregional therapy for HCC. As increasing attention is paid to the ablation margin， the goal of response evaluation for local ablation has shifted from “the achievement of imaging-defined complete ablation” to a new treatment paradigm of “no contrast-enhanced imaging， no ablation； no fusion imaging， no curative ablation”. This article reviews the technical advantages， clinical application value， treatment response assessment， fusion imaging strategies， and current limitations of CEUS in locoregional interventional diagnosis and treatment of HCC， in order to provide a reference for the individualized and precise management of HCC.