Contrast-enhanced ultrasonography in characterizing focal liver lesions

Contrast-enhanced ultrasonography (CEUS) became widely used as a method in characterizing focal liver lesions. The extensive use of imaging techniques in differential diagnosis of liver lesions and screening of hepatocellular carcinoma in patients with chronic hepatic diseases, has led to an important increase in identification of focal liver lesions. The second generation contrast agents, due to their intravascular distribution, allow a continuous evaluation of the enhancement pattern, which is crucial in characterization of liver lesions. The dual blood supply in the liver shows three different phases: arterial, portal and late phases. The enhancement during portal and late phases can give information about the lesion’s behavior. Each liver lesion has a different enhancement pattern that makes possible an accurate approach to their diagnosis. In this article, the advantages, indications and technique employed during CEUS and the different enhancement patterns of most benign and malignant focal liver lesions are discussed.