Clinical/methodical issue: Cross-sectional modalities or conventional ultrasound are not always able to sufficiently identify and characterize malignant liver lesions.
Standard radiological methods: The evaluation of malignant liver lesions in conventional ultrasound relies on echostructure, shape and borders, but often warrants additional contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) studies.
Methodical innovations: Contrast-enhanced ultrasound (CEUS) is a relatively safe imaging technique used for the detection and characterization of malignant liver lesions. The use of a second-generation contrast agent in dynamic real-time imaging allows the visualization of vascularization in any kind of liver lesion as well as liver perfusion during the arterial, portal venous and late phase.
Performance: Due to the different enhancement patterns, it is possible to differentiate a liver lesion with high diagnostic accuracy (over 90%).
Achievements: CEUS is a helpful complementary technique to cross-sectional imaging for the evaluation of unclear liver lesions and may frequently obviate additional contrast-enhanced MRI or CT studies.
Practical recommendations: CEUS enables the detection and characterization of liver lesions in real time.
Keywords: Hepatocellular carcinoma; Intrahepatic cholangiocarcinoma; Metastases; Ultrasound; Washout.