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Abdominal Radiology



Contrast-enhanced ultrasound (CEUS) is a useful tool to assess treatment response after percutaneous ablation or transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Here, we performed a systematic review and meta-analysis to evaluate the usefulness of CEUS in identifying residual tumor after locoregional therapy.


PubMed, Scopus, and Cochrane library databases were searched from their inception until March 8, 2021, for diagnostic test accuracy studies comparing CEUS to a reference standard for identifying residual tumors after locoregional therapy of HCC. The pooled sensitivity, specificity, accuracy, and diagnostic odds ratio (DOR) were obtained using a bivariate random effects model. Subgroup analyses were performed by stratifying the studies based on study design, type of locoregional therapy, CEUS criteria for residual tumor, timing of CEUS follow up, and type of standard reference.


Two reviewers independently evaluated 1479 publications. After full-text review, 142 studies were found to be relevant, and 43 publications (50 cohorts) were finally included. The overall sensitivity of CEUS in detection of residual disease estimated from the bivariate random effects model was 0.85 (95% CI 0.80–0.89). Similarly, the overall specificity was 0.94 (95% CI 0.91–0.96). The diagnostic accuracy was 93.5%. The DOR was 70.1 (95% CI 62.2–148), and the AUROC was 0.95. Importantly, subgroup analysis showed no apparent differences in the diagnostic performance between locoregional therapy (TACE vs. ablation) and criteria used to define residual enhancement, timing of performing CEUS, study design, or type of reference standard.


CEUS is a highly accurate method to identify HCC residual tumor after TACE or percutaneous ablation.

Authors: Yang Hai 1, Esika Savsani 1, Weelic Chong 23, John Eisenbrey 1, Andrej Lyshchik 4

1Department of Radiology, Thomas Jefferson University, Philadelphia, PA, 19107, USA.

2Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

3Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.

4Department of Radiology, Thomas Jefferson University, Philadelphia, PA, 19107, USA

Read full text at: volume 46, pages 5162–5179 (2021);

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