Contrast-enhanced ultrasound in the diagnosis of infiltrative hepatocellular carcinoma: A report of three cases

Infiltrative hepatocellular carcinoma (HCC) is a challenging imaging diagnosis due to its ill-defined appearance and variable enhancement, which may be difficult to distinguish from background changes from cirrhosis. The literature on the role of contrast-enhanced ultrasound (CEUS) in the diagnosis of infiltrative HCC is currently limited. CEUS has greater sensitivity for contrast enhancement due to its temporal resolution, and can be used when there is contraindication to CT or MRI contrast. We present 3 cases where CEUS aided in the diagnosis of infiltrative HCC in patients with equivocal CT and MRI findings and/or renal failure, with significant implications for management. As current guidelines focus on the role of CEUS in characterizing defined focal liver lesions or discrete observations on precontrast US, further studies are warranted to validate the utility of CEUS in the noninvasive diagnosis of infiltrative HCC and delineate its role in algorithms for imaging workup.