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초록

Unique among contrast agents, Sonazoid combines blood pool and Kupffer cell imaging capabilities. Despite this, its diagnostic criteria for hepatocellular carcinoma (HCC) remain unresolved, particularly concerning arterial phase hyperenhancement (APHE) and Kupffer phase imaging. Unlike other agents, perfluorobutane microbubbles, absorbed by Kupffer cells, enhance liver-to-lesion contrast, similar to Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) in magnetic resonance imaging (MRI). This unique property raises questions about whether “wash-out” on Sonazoid contrast-enhanced ultrasound (CEUS) including the Kupffer phase (h10 min) can be applied as a major feature of HCC. However, recent studies suggest that Kupffer phase washout can indeed be considered a key feature for HCC diagnosis with Sonazoid CEUS, without significantly reducing specificity. With this evidence, Sugimoto et al. suggested that nonrim APHE and Kupffer phase washout could be considered as diagnostic criteria for HCC and called as modified CEUS Liver Imaging Report and Data System (LI-RADS). Recently, guidelines from the Korean Society of Radiology (KSR) and the Korean Society of Abdominal Radiology (KSAR) were published to standardize Sonazoid CEUS in HCC diagnosis. This review discusses the characteristics and examination procedures of Sonazoid CEUS, including the development of a modified CEUS LI-RADS tailored to Sonazoid.

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