Contrast-Enhanced Ultrasound to Diagnose HCC Recommended in AASLD Guidelines

October 3, 2023—The International Contrast Ultrasound Society (ICUS), which is a dedicated to advancing the safe and medically appropriate use of contrast enhanced ultrasound (CEUS), announced that new physician guidelines recommend use of CEUS to diagnose hepatocellular carcinoma (HCC).

According to ICUS, the American Society for the Study of Liver Disease (AASLD) “Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma” by Amit G. Singal, MD, et al was published online in Hepatology in May 2023.

As noted in the ICUS press release, the AASLD guidance document states, “Recent studies demonstrate sufficiently high test performance for CEUS as a diagnostic modality,” and recommends CEUS for diagnosing HCC when magnetic resonance (MR) and CT are inconclusive, unavailable, or contraindicated.

ICUS outlined beneficial characteristics of CEUS, which include:

• CEUS is a relatively simple, low-cost, noninvasive diagnostic imaging modality that is safely and routinely used worldwide to enhance conventional diagnostic ultrasound imaging.
• CEUS uses FDA-approved microbubble ultrasound contrast agents (UCAs) administered intravenously during an ultrasound scan. UCAs do not contain dye, create no known risk of kidney damage or deposit of contrast media in the brain, and do not expose patients or hospital staff to ionizing radiation.
• CEUS may be used to identify and characterize tumors, monitor chronic gastrointestinal diseases, diagnose heart and vascular disease, evaluate other serious medical conditions, and monitor therapy.

“CEUS scans are very reliable for HCC diagnosis, with accuracy equivalent to MR and CT,” stated Andrej Lyshchik, MD, in the ICUS press release.

CEUS also is safer and less expensive than alternative forms of diagnostic imaging, and it provides diagnostic information in real time, noted Dr. Lyshchik. He added, “In some cases, CEUS can avoid delays associated with MR or CT, and that can help speed up the patient’s access to appropriate therapy.”

Dr. Lyshchik is a professor of radiology at Thomas Jefferson University in Philadelphia, Pennsylvania, and currently chairs the American College of Radiology’s Liver Imaging Reporting & Data System (LI-RADS) CEUS Working Group. He is a member of both the LI-RADS Steering Committee and the board of directors of ICUS.

CEUS is also recommended by guidelines promulgated by professional societies around the world, according to Fabio Piscaglia, MD.

Dr. Piscaglia is a professor of internal medicine at the University of Bologna and a past president of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). Dr. Piscaglia also is first author of the EFSUMB guidelines on nonhepatic clinical applications of CEUS, a coauthor of HCC guidelines of the European Association of the Study of Liver, and a board member of ICUS.

“CEUS is a very reliable, safe, low-cost diagnostic modality that improves patient outcomes and experiences, and often saves lives,” commented Dr. Piscaglia in the ICUS press release.

According to AASLD, liver cancer is the third leading cause of cancer-related deaths, and HCC disproportionately affects American Indian, Hispanic, and Black patients when compared to non-Hispanic White patients, noted the press release.

“We are concerned that without access to CEUS, minority patients with limited access to alternative imaging may be at even greater risk for misdiagnosis or missed diagnosis,” commented Yuko Kono, MD, in the ICUS press release.

Dr. Kono is a past chair of the American College of Radiology’s Liver Imaging & Reporting Data Systems (LI-RADS) CEUS Working Group and is a member of the board of directors of ICUS. Dr. Kono is a professor of radiology and medicine at the University of California San Diego in San Diego, California.

The press release further noted that AASLD guidelines are widely followed by physicians throughout North America. The new CEUS recommendations, Dr. Kono stated, “represent an important and appropriate step forward in integrating CEUS into modern imaging labs.”

ICUS offers free CME-accredited webinars on CEUS and other services for the global CEUS community.