Conventional ultrasound (US) has long been central to hepatocellular carcinoma (HCC) surveillance in cirrhotic patients, due to its low cost, wide availability, non-invasiveness, and adequate sensitivity for detecting small nodules. However, its specificity in distinguishing HCC from other lesions is limited. Contrast-enhanced ultrasound (CEUS) has significantly improved the characterization of nodules first identified on conventional US. Yet, when CEUS is performed using sulfur hexafluoride (SonoVue)—the only contrast agent available in Western countries—assessment remains restricted to a single nodule per examination, and enhanced CT or MRI is still required for full characterization and staging. In clinical settings, such as hepatology, internal medicine, infectious diseases, and surgery, CEUS offers the advantage of immediate availability, enabling rapid characterization of suspicious nodules in cirrhotic livers and facilitating timely therapeutic decisions. Although the introduction of direct-acting antivirals (DAAs) has substantially reduced HCV-related HCC, HCC incidence is increasingly driven by metabolic dysfunction-associated steatohepatitis (MASH). Evidence on surveillance strategies for MASH patients remains limited, and current EASL guidelines recommend monitoring only patients with >F2 fibrosis. Additionally, the effectiveness of US in obese or diabetic/obese populations is under ongoing investigation; abbreviated non-contrast MRI has been proposed as an alternative surveillance tool, but its adoption would entail significant economic implications for healthcare systems. HCC arising from MASH—sometimes even without cirrhosis—exhibits different sonographic and pathological features. Instead of small, hypoechoic nodules, typically seen in HCV-related cirrhosis, clinicians increasingly encounter larger or multiple lesions, often accompanied by macrovascular invasion, limiting access to curative treatments. Furthermore, typical CEUS LI-RADS patterns are less frequently observed. This review summarizes the evolving US findings in the era of MASH-related HCC and underscores the continued importance of US as the primary imaging tool in routine clinical practice.
传统超声因其成本低、普及广、无创性及对小结节检测的足够敏感性，长期以来一直是肝硬化患者肝细胞癌监测的核心手段。然而，其在区分肝细胞癌与其他病变方面的特异性有限。对比增强超声显著改善了传统超声首次发现结节的定性能力。但使用六氟化硫（声诺维）——西方国家唯一可用的造影剂——进行对比增强超声检查时，每次检查仍仅限于评估单个结节，且仍需增强CT或MRI进行全面定性和分期。在肝病科、内科、感染科及外科等临床环境中，对比增强超声具有即时可用的优势，能够快速定性肝硬化肝脏中的可疑结节，有助于及时制定治疗决策。尽管直接抗病毒药物的应用已显著降低HCV相关肝细胞癌发病率，但代谢功能障碍相关脂肪性肝炎正日益成为肝细胞癌发生的主要驱动因素。目前针对代谢功能障碍相关脂肪性肝炎患者的监测策略证据有限，现行欧洲肝脏研究学会指南仅建议对F2级以上纤维化患者进行监测。此外，超声在肥胖或糖尿病/肥胖人群中的有效性仍在持续研究中；简化版非增强MRI已被提议作为替代监测工具，但其应用将对医疗系统产生重大经济影响。源于代谢功能障碍相关脂肪性肝炎的肝细胞癌——有时甚至不伴肝硬化——表现出不同的超声和病理特征。与HCV相关肝硬化中典型的小型低回声结节不同，临床医生越来越多地遇到体积更大或多发病灶，常伴有大血管侵犯，限制了根治性治疗的实施。此外，典型的对比增强超声LI-RADS模式出现频率较低。本综述总结了代谢功能障碍相关脂肪性肝炎相关肝细胞癌时代不断演变的超声表现，并强调了超声作为常规临床实践中主要影像学工具的持续重要性。
肿瘤(癌症)患者之家