{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:49:58Z","timestamp":1789037398959,"version":"build-2803163510"},"reference-count":23,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"name":"Deutsche Gesellschaft f\u00fcr Ultraschall in der Medizin"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ultraschall Med"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n            Objectives Hepatocellular carcinoma (HCC) upon contrast-enhanced\n      ultrasound (CEUS) typically shows arterial phase hyperenhancement (APHE), followed by late\n      (&gt; 60 seconds) and mild contrast washout (WO). Although APHE is considered as the hallmark\n      of HCC, it can be absent in some HCCs. Thus, we explored which sonomorphological and\n      histopathological features of HCC are associated with a lack of APHE upon CEUS.<\/jats:p><jats:p>\n            Methods Focal liver lesions in high-risk patients for HCC were\n      assessed with CEUS following a standardized protocol in a prospective multi-center real-life\n      setting. CEUS patterns in HCC were assessed, and tumour and patient characteristics were\n      compared for HCCs with and without APHE.<\/jats:p><jats:p>\n            Results 316 patients with HCC were recruited (cirrhosis, 76.9%).\n      APHE occurred in 271\/316 HCCs (85.8%). A lack of APHE was associated with portal vein\n      thrombosis, tumour infiltration of the liver vessels (p&lt;0.001), larger size,\n      multilocularity, and higher depth location upon ultrasound (p&lt;0.01). Histological grading\n      did not differ between HCCs with and without APHE (p=0.39). Histopathological features of HCCs\n      without APHE included cirrhotic stromal reaction, marked tumour cell steatosis and absence of\n      the typical surrounding dilated sinusoidal vascular channels.<\/jats:p><jats:p>\n            Conclusion Correlation with histopathological findings support\n      the fact that HCCs with a lack of APHE in CEUS are a heterogeneous group. The examiner has to\n      be aware that particularly HCCs with portal vein thrombosis or macro-invasion of the liver vessels may lack\n      APHE.<\/jats:p>","DOI":"10.1055\/a-2034-1911","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T00:25:07Z","timestamp":1676334307000},"page":"606-613","source":"Crossref","is-referenced-by-count":5,"title":["HCCs lacking arterial phase hyperenhancement (APHE) on contrast-enhanced ultrasound (CEUS) \u2013 a diagnostic challenge. Findings from the prospective multicenter DEGUM CEUS HCC trial"],"prefix":"10.1055","volume":"44","clinical-trial-number":[{"clinical-trial-number":"nct03405909","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Deike","family":"Strobel","sequence":"additional","affiliation":[{"name":"Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas","family":"Agaimy","sequence":"additional","affiliation":[{"name":"Institute of Pathoogy, Erlangen University Hospital, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Jesper","sequence":"additional","affiliation":[{"name":"Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Zundler","sequence":"additional","affiliation":[{"name":"Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5499-6080","authenticated-orcid":false,"given":"Barbara","family":"Schellhaas","sequence":"additional","affiliation":[{"name":"Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1148\/radiol.2021211244","article-title":"CT\/MRI and CEUS LI-RADS Major Features Association with Hepatocellular Carcinoma:\n          Individual Patient Data 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Radiol"},{"issue":"11","key":"ref4","doi-asserted-by":"publisher","first-page":"3170","DOI":"10.1016\/j.ultrasmedbio.2021.07.010","article-title":"Contrast-Enhanced Ultrasound Patterns for the Non-invasive Diagnosis of\n          Hepatocellular Carcinoma: A Prospective Multicenter Study in Histologically Proven Liver\n          Lesions in a Real-Life Setting Demonstrating the Benefit of Extended Late Phase\n          Observation","volume":"47","author":"B Schellhaas","year":"2021","journal-title":"Ultrasound Med Biol"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jhep.2018.03.019","article-title":"EASL Clinical Practice Guidelines: Management of hepatocellular\n          carcinoma","volume":"69","author":"European Association for the Study of the Liver","year":"2018","journal-title":"J Hepatol"},{"issue":"04","key":"ref6","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1055\/a-0900-3962","article-title":"Tips and Tricks in 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