Table 2. Summary of Recommendation Statements.

Key Questions	Recommendations	Recommendation Level	Evidence Level	Agreement
1-1. Is it appropriate for nonrim APHE and late (≥ 60 s) and mild washout to be major imaging features of HCC in Sonazoid CEUS?	In Sonazoid CEUS, nonrim APHE and late (≥ 60 s) and mild washout are appropriate major imaging features for diagnosing HCC in at-risk patients.	Strongly	2	100% (18/18)
1-2. Can Kupffer phase washout be used as a major feature of HCC diagnosis in Sonazoid CEUS?	Kupffer phase washout can be considered another major imaging feature in Sonazoid CEUS for diagnosing HCC in at-risk patients if the lesions with nonrim APHE do not show either early or marked washout during the vascular phase.	Conditionally	2	100% (18/18)
2. What are the appropriate criteria for diagnosing HCC using Sonazoid CEUS in at-risk patients?	The diagnosis of HCC can be made in a nodule ≥ 1 cm detected in an at-risk patient when nonrim APHE with late and mild washout or washout in the Kupffer phase are present.	Conditionally	2	100% (18/18)
3. Can Sonazoid CEUS be used to characterize inconclusive nodules detected in CT or MRI in patients at high risk for HCC?	Sonazoid CEUS can be used to characterize nodules inconclusive in CT or MRI because it can detect the arterial hypervascularity of a nodule in real time and show Kupffer cell activity within the nodule.	Conditionally	3	88.9% (16/18)
4. Can Sonazoid CEUS differentiate HCC from non-HCC malignancies?	Sonazoid CEUS can differentiate HCC from non-HCC malignancies such as intrahepatic cholangiocarcinoma and metastasis.	Conditionally	3	88.9% (16/18)
5. Can Sonazoid CEUS be used as a surveillance tool for HCC in high-risk patients?	Sonazoid CEUS can be used as a surveillance tool in high-risk patients.	Conditionally	3	88.9% (16/18)
6. Is Sonazoid CEUS helpful for guiding local ablation therapy for HCC?	Sonazoid CEUS is helpful for guiding local ablation therapy because it increases the detectability and conspicuity of small HCCs that are inconspicuous on B-mode ultrasound.	Strongly	2	100% (18/18)
7. Is it appropriate to use Sonazoid CEUS to assess the treatment response of HCC in patients who underwent TACE or RFA?	When less than three index tumors can be observed with CEUS, Sonazoid CEUS may be useful for evaluating treatment response after TACE or RFA.	Conditionally	3	94.5% (17/18)

APHE = arterial phase hyperenhancement, CEUS = contrast-enhanced ultrasonography, HCC = hepatocellular carcinoma, CT = computed tomography, MRI = magnetic resonance imaging, TACE = transarterial chemoembolization, RFA = radiofrequency ablation