The use of 3D contrast-enhanced ultrasound in assessing the technical success rate of thermal ablation for hepatocellular Carcinoma: A meta-analysis

Objective To systematically evaluate the diagnostic accuracy of three-dimensional contrast-enhanced ultrasound (3D-CEUS) in assessing technical success rates (i.e., determining the presence of residual lesions or inadequate ablation margins) following thermal ablation for hepatocellular carcinoma (HCC). Methods We searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and VIP databases to collect literature on the use of 3D-CEUS for post-thermal ablation assessment of HCC from the inception of each database to 30 April 2026. Two researchers independently screened the literature and extracted data.The QUADAS-2 tool was used to assess the methodological quality of the included studies. A bivariate generalised linear mixed model was employed to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and pooled area under the receiver operating characteristic curve (AUC), and to assess heterogeneity. Results A total of 11 studies involving 631 HCC patients (693 lesions) were included. The pooled sensitivity of 3D-CEUS for detecting HCC was 0.85 (95% CI: 0.77–0.93), and the pooled specificity was 0.97 (95% CI: 0.95–0.99).The PLR was 28.67 (95% CI: 7.86–49.47), the NLR was 0.16 (95% CI: 0.07–0.24), and the DOR was 180.20 (95% CI: 59.00–554.50).The area under the SROC curve (AUC) was 0.971 (95% CI: 0.935–0.988). Heterogeneity tests indicated that both sensitivity (I 2 = 24.3%) and specificity (I 2 = 33.8%) were within acceptable ranges; no meta-regression analysis was performed. The Deeks funnel plot was symmetrical (P = 0.19), and no publication bias was detected. Conclusion 3D-CEUS demonstrates high diagnostic accuracy for assessing the technical success rate following thermal ablation for HCC and can serve as an effective imaging method for identifying residual lesions post-procedure.