Hepatocellular Carcinoma in Chronic Hepatitis B: The Role of Ultrasound in Surveillance
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Hepatitis B virus (HBV) infection remains one of the leading causes of hepatocellular carcinoma (HCC) worldwide and continues to represent a major global public health burden. Although HCC most commonly develops in cirrhotic liver, chronic hepatitis B (CHB) possesses direct oncogenic potential and may result in HCC development even in non-cirrhotic patients. Early detection through surveillance is essential for improving prognosis and enabling potentially curative treatment.
Ultrasound remains the primary imaging modality for HCC surveillance because of its accessibility, safety, repeatability, and cost-effectiveness. However, surveillance performance is strongly influenced by operator expertise, liver parenchymal characteristics, obesity, and visualization quality. Recent developments including the Liver Imaging Reporting and Data System (LI-RADS) US Surveillance algorithm, visualization scoring systems, transient elastography, and contrast-enhanced ultrasound (CEUS) have expanded the role of ultrasound in surveillance and lesion characterization. In addition, emerging technologies such as artificial intelligence-assisted imaging analysis and radiomics may improve early tumor detection and individualized risk stratification in the future.
This review summarizes current evidence regarding CHB-related HCC epidemiology, surveillance strategies, ultrasound-based imaging approaches, LI-RADS US Surveillance, CEUS applications, and future perspectives in personalized HCC surveillance.
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