Hepatocellular carcinoma (HCC) is the eighth most frequent tumour entity worldwide (one million per year). The incidence in the USA and elsewhere has increased, which is probably due to the rise in the incidence of hepatitis C virus infection. A number of cohort studies have shown that surveillance using abdominal ultrasound (US) improves management of HCC developing in cirrhotic patients as it allows early detection and application of potentially curative treatments.¹ Thus far it is not entirely clear whether surveillance increases survival as no randomised controlled trials have been conducted to answer this question. However, as eventually curative treatments such as resection, ablation, and in particular liver transplantation have emerged as effective means of treating HCC as long as it is not too large and too widespread, early diagnosis seems to be a reasonable goal in improving the poor prognosis of this cancer.^2–4 Interestingly, it has recently been shown by comparison of time periods that besides being part of the more recent cohort, tumour staging was the only independent predictor of survival.¹ Thus it seems obvious that detection of early carcinoma in liver cirrhosis would be a reasonable goal. Progress made in recent years regarding imaging, in particular spiral computed tomography and using the increased vascularity of HCC, allowing for better scanning protocols, has increased the detection rate significantly. In addition, magnetic resonance imaging has become the diagnostic procedure of choice in some institutions. However, most experts still advocate liver biopsy.^5–11

In addition, improved US techniques such as contrast enhancement with and without Doppler ultrasonography^12,13 may improve early diagnosis further. However, no adequate …