New Applications of Contrast-Enhanced Ultrasound for Hepatic Fibrosis and Portal Hypertension

Abstract

Liver biopsy and measurement of hepatic venous pressure gradient in patients with cirrhosis are the gold standards for estimation of hepatic fibrosis, and they have diagnostic and prognostic value. However, both approaches are invasive and cannot be used repeatedly in clinical practice. Ultrasonography (US) is safe, easy to perform, inexpensive, and yields numerical and accurate results. Contrast-enhanced US (CEUS) using second-generation microbubble ultrasonography agents (USA) is able to show the vascular structure and enhancement pattern of lesions and can be used in the diagnosis of hepatocellular carcinoma (HCC) due to its characteristic neovascularization. Beyond the diagnosis of HCC, functional US indices based on CEUS have been suggested as promising markers for fibrosis and portal hypertension (PH). Although investigations of the reproducibility and long-term prognostic value are needed, CEUS-based indices are promising quantitative non-invasive tests to estimate the severity of hepatic fibrosis and PH. Therefore, in this study, we describe the characteristics of second-generation microbubble USA and the usefulness of CEUS-based indices for hepatic fibrosis and PH.