Dynamic Contrast-Enhanced Ultrasound in the Prediction of Advanced Hepatocellular Carcinoma Response to Systemic and Locoregional Therapies

Simple Summary Hepatocellular carcinoma (HCC) is sometimes diagnosed at an advanced stage, with subsequent complex therapeutic efforts combining both locoregional and systemic treatments. Computed tomography and magnetic resonance are conventionally used for post-treatment follow-up of HCC. Contrast-enhanced ultrasound and dynamic contrast-enhanced ultrasound (DCE-US) have gained an increasing importance due to the interest of several researchers in their potential role in the early assessment of response to locoregional treatments or antiangiogenic therapies in patients with advanced HCC. Particularly, DCE-US allows the construction of time-intensity curves, providing an assessment of the parameters related to neoplastic tissue perfusion and its potential changes following therapies. Its advantage resides in being easily repeatable, minimally invasive, and able to grant important evaluations about patients' survival, essential for well-timed therapeutic changes in case of unsatisfying response and eventual further treatment planning.Abstract Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer and the sixth most common malignant tumor in the world, with an incidence of 2-8% per year in patients with hepatic cirrhosis or chronic hepatitis. Despite surveillance schedules, it is sometimes diagnosed at an advanced stage, requiring complex therapeutic efforts with both locoregional and systemic treatments. Traditional radiological tools (computed tomography and magnetic resonance) are used for the post-treatment follow-up of HCC. The first follow-up imaging is performed at 4 weeks after resection or locoregional treatments, or after 3 months from the beginning of systemic therapies, and subsequently every 3 months for the first 2 years. For this reason, these radiological methods do not grant the possibility of an early distinction between good and poor therapeutic response. Contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced ultrasound (DCE-US) have gained the interest of several researchers for their potential role in the early assessment of response to locoregional treatments (chemoembolization) or antiangiogenic therapies in patients with advanced HCC. In fact, DCE-US, through a quantitative analysis performed by specific software, allows the construction of time-intensity curves, providing an evaluation of the parameters related to neoplastic tissue perfusion and its potential changes following therapies. It has the invaluable advantage of being easily repeatable, minimally invasive, and able to grant important evaluations regarding patients' survival, essential for well-timed therapeutic changes in case of unsatisfying response, and eventual further treatment planning.