Differentiating between hepatocellular carcinoma and its mimickers using contrast-enhanced ultrasound with perflubutane microbubbles.

Abstract

Introduction: Contrast-enhanced ultrasound (CEUS) is performed to non-invasively confirm a diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. Typical imaging characteristics for HCC include non-rim arterial phase hyperenhancement (APHE), a washout appearance during the portal phase, and a defect in the Kupffer phase on CEUS using perflubutane microbubbles (Sonazoid). CEUS can show high diagnostic accuracy for HCC; however, we sometimes encounter challenging situations for diagnosing HCC.

Areas covered: Some HCCs do not show APHE or the washout appearance, and other hepatic malignancies may exhibit similar imaging findings and be misdiagnosed as HCC. In addition, HCC needs to be differentiated from various types of hypervascular benign liver lesions. This review focuses on atypical imaging findings for HCC and typical imaging findings for common mimics of HCC as well as appropriate diagnostic workups for these lesions. Additionally, the literature review methodology, encompassing searches in PubMed, from January 1995 to January 2025, is briefly outlined.

Expert opinion: Clinicians need to carefully consider the histopathological features, imaging characteristics, and differential diagnoses of hypervascular liver lesions in order to prevent a misdiagnosis and select appropriate treatment plans. A detailed understanding of typical and atypical imaging features may prevent the false-positive diagnosis of HCC.