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HCC in the Setting of Hepatitis B: Asia-Pacific Considerations

Grace LH Wong, MD
Released: June 8, 2021

Imaging Modalities for HCC Surveillance

Imaging Modalities for HCC Surveillance

Similar to other major regions of the world, we in the Asia-Pacific region continue to use ultrasonography as our first-line screening tool, in part because it is noninvasive and widely available. Ultrasonography is available in most clinics or hospitals in the region and the cost is relatively low. We also understand, however, the disadvantages of ultrasonography, including that the results are very operator dependent and the sensitivity in patients with obesity and with certain disease states is low. For example, if the lymph nodes are very fatty or the patient has thick subcutaneous fat, it is quite difficult to adequately visualize the whole liver.

In the Asia-Pacific region, we are now increasingly using CT, as it is becoming more widely available and has moderate to high resolution and high sensitivity. But because of the relatively high dose of radiation with CT, we prefer not to use this repeatedly, especially in young patients. The costs are also higher compared with ultrasonography.

MRI is also used for surveillance in some parts of the world. Because MRI is expensive and requires a large space to install, the availability is limited in lower-resource countries. The advantages of MRI include its high resolution and high sensitivity. Some healthcare providers will use noncontrast MRIs first; if using gadolinium as a contrast agent, there is a risk of gadolinium accumulation with repeated use.13

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