Perfluorobutane (Sonazoid) Contrast-enhanced ultrasound to diagnose hepatocellular carcinoma: A systematic review and meta-analysis

Yujia Chen, Wenjun Zhu, Yunyun Yi, Huali Cao, Fan Chen, Qinling Zhu


Aim: This meta-analysis aimed to assess the precision of Sonazoid contrast-enhanced ultrasound (CEUS) to distinguish hepatocellular carcinoma (HCC) from focal liver lesions (FLLs).

Material and methods: The Cochrane Library, Embase, PubMed, and Web of Science databases were systematically searched and checked for studies using Sonazoid CEUS to characterize HCC. A comprehensive meta-analysis was conducted, involving data pooling, subgroup analyses, meta-regression, and investigation of publication bias.

Results: The meta-analysis included fourteen studies. The overall diagnostic accuracy for characterizing HCC was as follows (all ranges show the 95% confidence interval): pooled sensitivity of 0.87 (0.80–0.92), pooled specificity of 0.95 (0.91–0.97), and a diagnostic odds ratio of 121 (61–241). The overall weighted area under the curve was 0.97 (0.95–0.98). The pooled sensitivity, specificity, and diagnostic odds ratio for Sonazoid and Sonovue were 0.75 (0.63– 0.84), 0.97 (0.86–0.99), 82 (15–445); and 0.64 (0.51–0.76), 0.98 (0.91–0.99), 72 (17–311), respectively. The sources of heterogeneity were identified as the study location, prevailing risk factor, reference diagnosis standard, criteria of Sonazoid CUES, and the proportion of cases of HCC. We observed no potential publication bias.

Conclusion: Sonazoid CEUS is efficient to distinguish HCC from FLLs, with good sensitivity and specificity. It is comparable to Sonovue CEUS to diagnose HCC.


Perfluorobutane; Sonazoid; Contrast-enhanced ultrasound; Hepatocellular carcinoma; Meta-analysis



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