Application of new ultrasound techniques for focal liver lesions

  • 14 Accesses


Ultrasonography (US) has the overwhelming advantages of not entailing radiation exposure and being a noninvasive, real-time, convenient, easy-to-perform, and relatively inexpensive imaging modality. It is used as the first-line imaging modality for screening, detection, and diagnosis of focal liver lesions (FLLs) [small hepatocellular carcinomas (HCCs), in particular]. However, with the increasing demand for accurate and early diagnosis of small HCCs, newer radiologic methods need to be explored to overcome certain limitations of US. For example, the imaging is easily negatively affected by the presence of gas, rib cage, and subcutaneous fat, and is insensitive for capturing the subtle but vital information on the blood flow. It was in response to this need that new promising technologies such as contrast-enhanced ultrasound and fusion imaging were introduced for the detection of liver lesions. This paper presents an overview of the epidemiology and mechanisms of the development of HCCs, with an emphasis on the application of US in the diagnosis and treatment of FLLs. The aim of this article is to provide the state-of-the-art developments in the imaging diagnosis of FLLs and evaluation of ablation treatment of early HCCs. By keeping abreast of these recent advances, we hope that doctors and researchers working in the field of diagnosis/treatment of liver diseases will be able to discriminate benign FLLs such as regenerative nodules and focal nodular hyperplasia from HCCs, so as to avoid unnecessary repeated tumor biopsies and overtreatment. In particular, we expect that small HCCs or precancerous nodules (such as dysplastic nodules) can be accurately diagnosed and appropriately treated even at an early stage.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16



Contrast-enhanced ultrasound


Cholangiolocellular carcinoma


Dysplastic nodule


Focal liver lesion


Focal nodular hyperplasia


Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid magnetic resonance imaging


Hepatobiliary phase


Hepatocellular carcinoma


Intrahepatic cholangiocarcinoma


Mechanical index


Radiofrequency ablation


Regenerative nodule


Superb microvascular Imaging




Ultrasound contrast agent


  1. 1.

    Lafaro KJ, Demirjian AN, Pawlik TM. Epidemiology of hepatocellular carcinoma. Surg Oncol Clin N Am. 2015;24:1–17.

  2. 2.

    Njei B, Rotman Y, Ditah I, et al. Emerging trends in hepatocellular carcinoma incidence and mortality. Hepatology. 2015;61:191–9.

  3. 3.

    Singal AG, El-Serag HB. Hepatocellular carcinoma from epidemiology to prevention: translating knowledge into practice. Clin Gastroenterol Hepatol. 2015;13:2140–51.

  4. 4.

    Omata M, Cheng AL, Kokudo N, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: A 2017 update. Hepatol Int. 2017;11:317–70.

  5. 5.

    Jiang HY, Chen J, Xia CC, et al. Noninvasive imaging of hepatocellular carcinoma: from diagnosis to prognosis. World J Gastroenterol. 2018;24:2348–62.

  6. 6.

    Miller ZA, Lee KS. Screening for hepatocellular carcinoma in high-risk populations. Clin Imaging. 2016;40:311–4.

  7. 7.

    European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182–236.

  8. 8.

    Tang A, Hallouch O, Chernyak V, et al. Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis. Abdom Radiol (NY). 2018;43:13–25.

  9. 9.

    Cassinotto C, Aube C, Dohan A. Diagnosis of hepatocellular carcinoma: An update on international guidelines. Diagn Interv Imaging. 2017;98:379–91.

  10. 10.

    De Cobelli F, Marra P, Ratti F, et al. Microwave ablation of liver malignancies: comparison of effects and early outcomes of percutaneous and intraoperative approaches with different liver conditions: new advances in interventional oncology: state of the art. Med Oncol. 2017;34:49.

  11. 11.

    Santambrogio R, Cigala C, Barabino M, et al. Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: prospective comparison with pathology. Liver Int. 2018;38:312–20.

  12. 12.

    Chung YE, Kim KW. Contrast-enhanced ultrasonography: advance and current status in abdominal imaging. Ultrasonography. 2015;34:3–18.

  13. 13.

    Park AY, Seo BK. Up-to-date Doppler techniques for breast tumor vascularity: superb microvascular imaging and contrast-enhanced ultrasound. Ultrasonography. 2018;37:98–106.

  14. 14.

    Mao Y, Mu J, Zhao J, et al. The value of superb microvascular imaging in differentiating benign renal mass from malignant renal tumor: a retrospective study. Br J Radiol. 2018;91:20170601.

  15. 15.

    Jiang ZZ, Huang YH, Shen HL, et al. Clinical applications of superb microvascular imaging in the liver, breast, thyroid, skeletal muscle, and carotid plaques. J Ultrasound Med. 2019;38:2811–20

  16. 16.

    Dubinsky TJ, Revels J, Wang S, et al. Comparison of superb microvascular imaging with color flow and power Doppler imaging of small hepatocellular carcinomas. J Ultrasound Med. 2018;37:2915–24.

  17. 17.

    Bonacchi G, Becciolini M, Seghieri M. Superb microvascular imaging: a potential tool in the detection of FNH. J Ultrasound. 2017;20:179–80.

  18. 18.

    Kim TH, Kim SY, Tang A, et al. Comparison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma: 2018 update. Clin Mol Hepatol. 2019;25:245–63

  19. 19.

    Nevin YUEYK. Screening for hepatocellular carcinoma: summary of current guidelines up to 2018. Hepatoma Res. 2018;46:1–10.

  20. 20.

    Ungtrakul T, Mahidol C, Chun-On P, et al. Hepatocellular carcinoma screening and surveillance in 2293 chronic hepatitis B patients in an endemic area. World J Gastroenterol. 2016;22:7806–12.

  21. 21.

    Morgan TA, Maturen KE, Dahiya N, et al. US LI-RADS: ultrasound liver imaging reporting and data system for screening and surveillance of hepatocellular carcinoma. Abdom Radiol (NY). 2018;43:41–55.

  22. 22.

    Shiha G, Ibrahim A, Helmy A, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol Int. 2017;11:1–30.

  23. 23.

    Kim MJ, Lim JH, Lee SJ, et al. Correlation between the echogenicity of dysplastic nodules and their histopathologically determined fat content. J Ultrasound Med. 2003;22:327–34.

  24. 24.

    Numata K, Fukuda H, Nihonmatsu H, et al. Use of vessel patterns on contrast-enhanced ultrasonography using a perflubutane-based contrast agent for the differential diagnosis of regenerative nodules from early hepatocellular carcinoma or high-grade dysplastic nodules in patients with chronic liver disease. Abdom Imaging. 2015;40:2372–83.

  25. 25.

    Choi JY, Lee HC, Yim JH, et al. Focal nodular hyperplasia or focal nodular hyperplasia-like lesions of the liver: a special emphasis on diagnosis. J Gastroenterol Hepatol. 2011;26:1004–9.

  26. 26.

    Party IW. Terminology of nodular hepatocellular lesions. Hepatology. 1995;22:983–93.

  27. 27.

    Maruyama H, Yoshikawa M, Yokosuka O. Current role of ultrasound for the management of hepatocellular carcinoma. World J Gastroenterol. 2008;14:1710–9.

  28. 28.

    Bajenaru N, Balaban V, Savulescu F, et al. Hepatic hemangioma—review. J Med Life. 2015;8:4–11.

  29. 29.

    Murakami T, Tsurusaki M. Hypervascular benign and malignant liver tumors that require differentiation from hepatocellular carcinoma: key points of imaging diagnosis. Liver Cancer. 2014;3:85–96.

  30. 30.

    Lee DH, Lee JY, Han JK. Superb microvascular imaging technology for ultrasound examinations: initial experiences for hepatic tumors. Eur J Radiol. 2016;85:2090–5.

  31. 31.

    Oliveira IS, Kilcoyne A, Everett JM, et al. Cholangiocarcinoma: classification, diagnosis, staging, imaging features, and management. Abdom Radiol (NY). 2017;42:1637–49.

  32. 32.

    Neumaier CE, Bertolotto M, Perrone R, et al. Staging of hilar cholangiocarcinoma with ultrasound. J Clin Ultrasound. 1995;23:173–8.

  33. 33.

    Sidhu PS, Cantisani V, Dietrich CF, et al. The EFSUMB guidelines and recommendations for the clinical practice of Contrast-Enhanced Ultrasound (CEUS) in non-hepatic applications: update 2017 (short version). Ultraschall Med. 2018;39:154–80.

  34. 34.

    Piscaglia F, Bolondi L. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol. 2006;32:1369–75.

  35. 35.

    Chou Y, Liang J, Wang S, et al. Safety of perfluorobutane (Sonazoid) in characterizing focal liver lesions. J Med Ultrasound. 2019;27:81.

  36. 36.

    Dietrich CF, Averkiou M, Nielsen MB, et al. How to perform contrast-enhanced ultrasound (CEUS). Ultrasound Int Open. 2018;4:E2–15.

  37. 37.

    Hatanaka K, Kudo M, Minami Y, et al. Sonazoid-enhanced ultrasonography for diagnosis of hepatic malignancies: comparison with contrast-enhanced CT. Oncology. 2008;75:42–7.

  38. 38.

    Numata K, Fukuda H, Miwa H, et al. Contrast-enhanced ultrasonography findings using a perflubutane-based contrast agent in patients with early hepatocellular carcinoma. Eur J Radiol. 2014;83:95–102.

  39. 39.

    Westwood M, Joore M, Grutters J, et al. Contrast-enhanced ultrasound using SonoVue(R) (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2013;17:1–243.

  40. 40.

    Tanaka H, Iijima H, Nouso K, et al. Cost-effectiveness analysis on the surveillance for hepatocellular carcinoma in liver cirrhosis patients using contrast-enhanced ultrasonography. Hepatol Res. 2012;42:376–84.

  41. 41.

    Zhai HY, Liang P, Yu J, et al. Comparison of sonazoid and SonoVue in the diagnosis of focal liver lesions: a preliminary study. J Ultrasound Med. 2019;38:2417–25.

  42. 42.

    Deng H, Shi H, Lei J, et al. A meta-analysis of contrast-enhanced ultrasound for small hepatocellular carcinoma diagnosis. J Cancer Res Ther. 2016;12:C274–6.

  43. 43.

    von Herbay A, Vogt C, Willers R, et al. Real-time imaging with the sonographic contrast agent SonoVue: differentiation between benign and malignant hepatic lesions. J Ultrasound Med. 2004;23:1557–68.

  44. 44.

    Xu HX, Lu MD, Liu LN, et al. Discrimination between neoplastic and non-neoplastic lesions in cirrhotic liver using contrast-enhanced ultrasound. Br J Radiol. 2012;85:1376–84.

  45. 45.

    Chen MH, Yang W, Dai Y, et al. High mechanical index post-contrast ultrasonography improves tissue structural display of hepatocellular carcinoma. Chin Med J (Engl). 2005;118:2046–51.

  46. 46.

    Yang W, Chen MH, Wu W, et al. Effects of Gray-Scale ultrasonography immediate Post-Contrast on characterization of focal liver lesions. Biomed Res Int. 2015;2015:193178.

  47. 47.

    Kudo M, Ueshima K, Osaki Y, Hirooka M, Imai Y, Aso K, Numata K, Kitano M, Kumada T, Izumi N, Sumino Y. B-mode ultrasonography versus contrast-enhanced ultrasonography for surveillance of hepatocellular carcinoma: a prospective multicenter randomized controlled trial. Liver Cancer. 2019;4:271–80.

  48. 48.

    Wu M, Li L, Wang J, et al. Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysis. Eur Radiol. 2018;28:2077–88.

  49. 49.

    Shi W, He Y, Ding W, et al. Contrast-enhanced ultrasonography used for post-treatment responses evaluation of radiofrequency ablations for hepatocellular carcinoma: a meta-analysis. Br J Radiol. 2016;89:20150973.

  50. 50.

    Claudon M, Dietrich CF, Choi BI, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver–update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med. 2013;34:11–29.

  51. 51.

    Mauri G, Porazzi E, Cova L, et al. Intraprocedural contrast-enhanced ultrasound (CEUS) in liver percutaneous radiofrequency ablation: clinical impact and health technology assessment. Insights Imaging. 2014;5:209–16.

  52. 52.

    Nanashima A, Tobinaga S, Abo T, et al. Usefulness of sonazoid-ultrasonography during hepatectomy in patients with liver tumors: a preliminary study. J Surg Oncol. 2011;103:152–7.

  53. 53.

    Numata K, Morimoto M, Ogura T, et al. Ablation therapy guided by contrast-enhanced sonography with Sonazoid for hepatocellular carcinoma lesions not detected by conventional sonography. J Ultrasound Med. 2008;27:395–406.

  54. 54.

    Nihonmatsu H, Numata K, Fukuda H, et al. Low mechanical index contrast mode versus high mechanical index contrast mode: which is a more sensitive method for detecting Sonazoid microbubbles in the liver of normal subjects? J Med Ultrason. 2001;2016:211–7.

  55. 55.

    Blomley MJ, Albrecht T, Cosgrove DO, et al. Improved imaging of liver metastases with stimulated acoustic emission in the late phase of enhancement with the US contrast agent SH U 508A: Early experience. Radiology. 1999;210:409–16.

  56. 56.

    Takizawa K, Numata K, Morimoto M, et al. Use of contrast-enhanced ultrasonography with a perflubutane-based contrast agent performed one day after transarterial chemoembolization for the early assessment of residual viable hepatocellular carcinoma. Eur J Radiol. 2013;82:1471–80.

  57. 57.

    Luo W, Numata K, Kondo M, et al. Sonazoid-enhanced ultrasonography for evaluation of the enhancement patterns of focal liver tumors in the late phase by intermittent imaging with a high mechanical index. J Ultrasound Med. 2009;28:439–48.

  58. 58.

    Duisyenbi Z, Numata K, Nihonmatsu H, et al. Comparison between low mechanical index and high mechanical index contrast modes of contrast-enhanced ultrasonography: evaluation of perfusion defects of hypervascular hepatocellular carcinomas during the post-vascular phase. J Ultrasound Med. 2019;38:2329–38.

  59. 59.

    Luo W, Numata K, Morimoto M, et al. Clinical utility of contrast-enhanced three-dimensional ultrasound imaging with Sonazoid: findings on hepatocellular carcinoma lesions. Eur J Radiol. 2009;72:425–31.

  60. 60.

    Luo W, Numata K, Morimoto M, et al. Three-dimensional contrast-enhanced sonography of vascular patterns of focal liver tumors: pilot study of visualization methods. AJR Am J Roentgenol. 2009;192:165–73.

  61. 61.

    Luo W, Numata K, Morimoto M, et al. Focal liver tumors: characterization with 3D perflubutane microbubble contrast agent-enhanced US versus 3D contrast-enhanced multidetector CT. Radiology. 2009;251:287–95.

  62. 62.

    Luo W, Numata K, Morimoto M, et al. Differentiation of focal liver lesions using three-dimensional ultrasonography: retrospective and prospective studies. World J Gastroenterol. 2010;16:2109–19.

  63. 63.

    Luo W, Numata K, Morimoto M, et al. Role of Sonazoid-enhanced three-dimensional ultrasonography in the evaluation of percutaneous radiofrequency ablation of hepatocellular carcinoma. Eur J Radiol. 2010;75:91–7.

  64. 64.

    Numata K, Fukuda H, Ohto M, et al. Evaluation of the therapeutic efficacy of high-intensity focused ultrasound ablation of hepatocellular carcinoma by three-dimensional sonography with a perflubutane-based contrast agent. Eur J Radiol. 2010;75:e67–75.

  65. 65.

    Sugimori K, Numata K, Okada M, et al. Central vascular structures as a characteristic finding of regenerative nodules using hepatobiliary phase gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid-enhanced MRI and arterial dominant phase contrast-enhanced US. J Med Ultrason. 2001;2017:89–100.

  66. 66.

    Nishigori S, Numata K, Irie K, et al. Fusion imaging with contrast-enhanced ultrasonography for evaluating the early therapeutic efficacy of radiofrequency ablation for small hypervascular hepatocellular carcinomas with iso-echoic or unclear margins on conventional ultrasonography. J Med Ultrason. 2001;2018:405–15.

  67. 67.

    Kudo M, Hatanaka K, Maekawa K. Newly developed novel ultrasound technique, defect reperfusion ultrasound imaging, using sonazoid in the management of hepatocellular carcinoma. Oncology. 2010;78:40–5.

  68. 68.

    Kozaka K, Kobayashi S, Yoneda N, et al. Doughnut-like hyperintense nodules on hepatobiliary phase without arterial-phase hyperenhancement in cirrhotic liver: Imaging and clinicopathological features. Eur Radiol. 2019;29:6489–98

  69. 69.

    Maruyama H, Takahashi M, Sekimoto T, et al. Heterogeneity of microbubble accumulation: a novel approach to discriminate between well-differentiated hepatocellular carcinomas and regenerative nodules. Ultrasound Med Biol. 2012;38:383–8.

  70. 70.

    Lim JH, Kim EY, Lee WJ, et al. Regenerative nodules in liver cirrhosis: findings at CT during arterial portography and CT hepatic arteriography with histopathologic correlation. Radiology. 1999;210:451–8.

  71. 71.

    Suzuki M, Maeyama S, Takahashi H, et al. Strategy for hepatic hyperplastic nodules in heavy drinkers. Alcohol Clin Exp Res. 2004;28:153S–8S.

  72. 72.

    Zhang R, Qin S, Zhou Y, et al. Comparison of imaging characteristics between hepatic benign regenerative nodules and hepatocellular carcinomas associated with Budd-Chiari syndrome by contrast enhanced ultrasound. Eur J Radiol. 2012;81:2984–9.

  73. 73.

    Lee J, Jeong WK, Lim HK, et al. Focal nodular hyperplasia of the liver: contrast-enhanced ultrasonographic features with sonazoid. J Ultrasound Med. 2018;37:1473–80.

  74. 74.

    Sciarra A, Di Tommaso L, Nakano M, et al. Morphophenotypic changes in human multistep hepatocarcinogenesis with translational implications. J Hepatol. 2016;64:87–93.

  75. 75.

    Guo LH, Xu HX. Contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: controversy over the ASSLD guideline. Biomed Res Int. 2015;2015:349172.

  76. 76.

    Joshita S, Ichijo T, Suzuki F, et al. A case of well-differentiated cholangiolocellular carcinoma visualized with contrast-enhanced ultrasonography using Sonazoid. Hepatol Res. 2009;39:207–12.

  77. 77.

    Ishii N, Suzuki H, Tsukagoshi M, et al. Giant cholangiolocellular carcinoma with early recurrence that was difficult to distinguish from cholangiocellular carcinoma: report of a case. Int Surg. 2015;100:1111–6.

  78. 78.

    Ishii N, Araki K, Yamanaka T, et al. Small cholangiolocellular carcinoma that was difficult to distinguish from cholangiocellular carcinoma: a case report. Surg Case Rep. 2017;3:103.

  79. 79.

    Dietrich CF, Tannapfel A, Jang HJ, et al. Ultrasound imaging of hepatocellular adenoma using the new histology classification. Ultrasound Med Biol. 2019;45:1–10.

  80. 80.

    Yoshioka M, Watanabe G, Uchinami H, et al. Hepatic angiomyolipoma: differential diagnosis from other liver tumors in a special reference to vascular imaging—importance of early drainage vein. Surg Case Rep. 2015;1:11.

  81. 81.

    Numata K. Advances in ultrasound systems for hepatic lesions in Japan. J Med Ultrason. 2015;42:297–301.

  82. 82.

    Ichikawa T, Sano K, Morisaka H. Diagnosis of pathologically early HCC with EOB-MRI: experiences and current consensus. Liver Cancer. 2014;3:97–107.

  83. 83.

    Kudo M, Matsui O, Izumi N, et al. JSH Consensus-Based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the liver cancer study group of japan. Liver Cancer. 2014;3:458–68.

  84. 84.

    Kudo M. Breakthrough imaging in hepatocellular carcinoma. Liver Cancer. 2016;5:47–54.

  85. 85.

    Campos JT, Sirlin CB, Choi JY. Focal hepatic lesions in Gd-EOB-DTPA enhanced MRI: the atlas. Insights Imaging. 2012;3:451–74.

  86. 86.

    Zech CJ, Grazioli L, Breuer J, et al. Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA-enhanced liver magnetic resonance imaging: results of a multicenter trial. Investig Radiol. 2008;43:504–11.

  87. 87.

    Liu X, Jiang H, Chen J, et al. Gadoxetic acid disodium-enhanced magnetic resonance imaging outperformed multidetector computed tomography in diagnosing small hepatocellular carcinoma: a meta-analysis. Liver Transpl. 2017;23:1505–18.

  88. 88.

    Joo I, Lee JM. Recent advances in the imaging diagnosis of hepatocellular carcinoma: value of gadoxetic acid-Enhanced MRI. Liver Cancer. 2016;5:67–87.

  89. 89.

    Kudo M. Defect reperfusion imaging with Sonazoid(R): a breakthrough in hepatocellular carcinoma. Liver Cancer. 2016;5:1–07.

  90. 90.

    Jang JY, Kim MY, Jeong SW, et al. Current consensus and guidelines of contrast enhanced ultrasound for the characterization of focal liver lesions. Clin Mol Hepatol. 2013;19:1–16.

  91. 91.

    Kudo M, Hatanaka K, Kumada T, et al. Double-contrast ultrasound: a novel surveillance tool for hepatocellular carcinoma. Am J Gastroenterol. 2011;106:368–70.

  92. 92.

    Ntoulia A, Anupindi SA, Darge K, et al. Applications of contrast-enhanced ultrasound in the pediatric abdomen. Abdom Radiol (NY). 2018;43:948–59.

  93. 93.

    Ungermann L, Elias P, Zizka J, et al. Focal nodular hyperplasia: spoke-wheel arterial pattern and other signs on dynamic contrast-enhanced ultrasonography. Eur J Radiol. 2007;63:290–4.

  94. 94.

    Giorgio A, Calisti G, di Sarno A, et al. Characterization of dysplastic nodules, early hepatocellular carcinoma and progressed hepatocellular carcinoma in cirrhosis with contrast-enhanced ultrasound. Anticancer Res. 2011;31:3977–82.

  95. 95.

    Endo K, Kuroda H, Kakisaka K, et al. Hepatic angiomyolipoma staining in the post-vascular phase of contrast-enhanced ultrasound due to the presence of macrophages. Intern Med. 2018;57:1247–51.

Download references


The research-related costs of staying in Yokohama and concentrating on preparing the paper in Japan were supported by Natural Science Foundation of Shaanxi Province (No. 2018SF-245) of China and Fundamental Research Funds for the Central Universities (Grant number 1191329109).

Author information

Correspondence to Kazushi Numata.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wang, F., Numata, K., Nihonmatsu, H. et al. Application of new ultrasound techniques for focal liver lesions. J Med Ultrasonics (2020).

Download citation


  • Contrast-enhanced ultrasound
  • Fusion imaging
  • Focal liver lesions
  • Hepatocellular carcinoma