Current advancements and future directions in contrast-enhanced ultrasound (CEUS) in liver oncology: from quantification to theranostics.

Contrast-enhanced ultrasound has evolved into a precision supportive tool in managing liver oncology, particularly for hepatocellular carcinoma. It has moved beyond simple visual impressions to objective, quantitative data using dynamic contrast-enhanced ultrasound, perfusion curve analysis, and 3D-volumetric assessments. Furthermore, the integration of fusion imaging and artificial intelligence-driven pipelines has made ultrasound indispensable for guiding complex interventional procedures in real-time. In parallel, emerging technologies like targeted microbubbles and ultrasound-targeted microbubble destruction are pushing the field toward molecular imaging and theranostics, turning ultrasound into an active participant in therapy. This review examines these clinical applications, takes a critical look at persistent hurdles, and identifies current research directions.