Can contrast-enhanced ultrasound with perfluorobutane add value in detection of hepatocellular carcinoma in cirrhosis during surveillance?

Ultrasound (US) plays a pivotal role in the recognition of hepatocellular carcinoma (HCC) in cirrhosis (1). HCC represents the sixth most common malignancy and the fourth most frequent cause of cancer-related death in the world (2). Since the early 1980s, the US has described the fundamental findings of the HCC nodules appearing in a cirrhotic liver and significantly contributed to the knowledge of the natural history of this malignancy (3).