Abdominal Radiology

, Volume 43, Issue 5, pp 1128–1133 | Cite as

Contrast enhanced ultrasound for focal liver lesions: how accurate is it?

  • Richard G. Barr


With the recent FDA approval for characterization of focal liver lesions (FLL) in both pediatric and adult patients using Lumason (sulfur hexafluoride microbubbles), increased use of ultrasound contrast for routine clinical use is expected. This agent has been available for many years in Europe and Asia, and a large body of literature is available regarding the sensitivity and specificity of this agent. In addition, a few studies have directly compared CEUS to CECT and CEMRI for the characterization of focal liver lesions. This paper reviews the literature to provide a background to investigators in the United States as to the accuracy of CEUS in the characterization of FLL. This paper reviews the literature regarding sulfur hexafluoride microbubbles (Lumason in the USA and Sonovue in the rest of the world) since it is the only FDA approved agent in the USA for characterization of FLL. The results of other ultrasound contrast agents which are not FDA approved for abdominal indications (approval for cardiac indications) most likely will have similar results.


Contrast enhanced ultrasound Focal liver lesions Sensitivity 


Compliance with ethical standards


There was not funding for this study.

Conflict of interests

The author has these conflicts of interest:- Research Grants: Siemens Ultrasound, Philips Ultrasound, SuperSonic Imagine, Hitachi-Aloki. Advisory Panel; Bracco Diagnostics, Lantheus Medical. Speakers Bureau: Philips Ultrasound, Bracco Diagnostics. Royalties: Thieme Publishers.

Ethical approval

Not required for prospective article.


  1. 1.
    Friedrich-Rust M, Klopffleisch T, Nierhoff J, et al. (2013) Contrast-enhanced ultrasound for the differentiation of benign and malignant focal liver lesions: a meta-analysis. Liver Int 33(5):739–755CrossRefPubMedGoogle Scholar
  2. 2.
    Niu Y, Huang T, Lian F, Li F (2013) Contrast-enhanced ultrasonography for the diagnosis of small hepatocellular carcinoma: a meta-analysis and meta-regression analysis. Tumour Biol 34(6):3667–3674CrossRefPubMedGoogle Scholar
  3. 3.
    Guang Y, Xie L, Ding H, Cai A, Huang Y (2011) Diagnosis value of focal liver lesions with SonoVue(R)-enhanced ultrasound compared with contrast-enhanced computed tomography and contrast-enhanced MRI: a meta-analysis. J Cancer Res Clin Oncol 137(11):1595–1605CrossRefPubMedGoogle Scholar
  4. 4.
    Trillaud H, Bruel JM, Valette PJ, et al. (2009) Characterization of focal liver lesions with SonoVue-enhanced sonography: international multicenter-study in comparison to CT and MRI. World J Gastroenterol 15(30):3748–3756CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Quaia E, Calliada F, Bertolotto M, et al. (2004) Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232(2):420–430CrossRefPubMedGoogle Scholar
  6. 6.
    Anaye A, Perrenoud G, Rognin N, et al. (2011) Differentiation of focal liver lesions: usefulness of parametric imaging with contrast-enhanced US. Radiology 261(1):300–310CrossRefPubMedGoogle Scholar
  7. 7.
    Strobel D, Seitz K, Blank W, et al. (2009) Tumor-specific vascularization pattern of liver metastasis, hepatocellular carcinoma, hemangioma and focal nodular hyperplasia in the differential diagnosis of 1349 liver lesions in contrast-enhanced ultrasound (CEUS). Ultraschall Med 30(4):376–382CrossRefPubMedGoogle Scholar
  8. 8.
    D’Onofrio M, Crosara S, De Robertis R, et al. (2014) Malignant focal liver lesions at contrast-enhanced ultrasonography and magnetic resonance with hepatospecific contrast agent. Ultrasound 22(2):91–98CrossRefPubMedGoogle Scholar
  9. 9.
    Jacob J, Deganello A, Sellars ME, Hadzic N, Sidhu PS (2013) Contrast enhanced ultrasound (CEUS) characterization of grey-scale sonographic indeterminate focal liver lesions in pediatric practice. Ultraschall Med 34(6):529–540CrossRefPubMedGoogle Scholar
  10. 10.
    Dai Y, Chen MH, Yin SS, et al. (2007) Focal liver lesions: can SonoVue-enhanced ultrasound be used to differentiate malignant from benign lesions? Invest Radiol 42(8):596–603CrossRefPubMedGoogle Scholar
  11. 11.
    Seitz K, Strobel D, Bernatik T, et al. (2009) Contrast-Enhanced Ultrasound (CEUS) for the characterization of focal liver lesions—prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial). Parts of this manuscript were presented at the ultrasound dreilandertreffen 2008, Davos. Ultraschall Med 30(4):383–389CrossRefPubMedGoogle Scholar
  12. 12.
    Seitz K, Bernatik T, Strobel D, et al. (2010) Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions in clinical practice (DEGUM multicenter trial): CEUS vs. MRI—a prospective comparison in 269 patients. Ultraschall Med 31(5):492–499CrossRefPubMedGoogle Scholar
  13. 13.
    Hanna RF, Miloushev VZ, Tang A, et al. (2016) Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma. Abdom Radiol (NY) 41(1):71–90CrossRefGoogle Scholar
  14. 14.
    Han J, Liu Y, Han F, et al. (2015) The degree of contrast washout on contrast-enhanced ultrasound in distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma. Ultrasound Med Biol 41(12):3088–3095CrossRefPubMedGoogle Scholar
  15. 15.
    Li R, Yuan MX, Ma KS, et al. (2014) Detailed analysis of temporal features on contrast enhanced ultrasound may help differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma in cirrhosis. PLoS One 9(5):e98612CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Wildner D, Bernatik T, Greis C, et al. (2015) CEUS in hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in 320 patients—early or late washout matters: a subanalysis of the DEGUM multicenter trial. Ultraschall Med 36(2):132–139CrossRefPubMedGoogle Scholar
  17. 17.
    Wildner D, Pfeifer L, Goertz RS, et al. (2014) Dynamic contrast-enhanced ultrasound (DCE-US) for the characterization of hepatocellular carcinoma and cholangiocellular carcinoma. Ultraschall Med 35(6):522–527CrossRefPubMedGoogle Scholar
  18. 18.
    Lorusso A, Quaia E, Poillucci G, et al. (2015) Activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) related to the diagnostic impact in focal liver lesion characterisation. Insights Imaging 6(4):499–508CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Westwood M, Joore M, Grutters J, et al. (2013) 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 17(16):1–243CrossRefGoogle Scholar
  20. 20.
    Claudon M, Dietrich CF, Choi BI, et al. (2013) 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. Ultrasound Med Biol 39(2):187–210CrossRefPubMedGoogle Scholar
  21. 21.
    Personnel communication Edward G. Grant, Professor and Chairman, Dept. of Radiology, University of Southern California. June 24, 2017.Google Scholar
  22. 22.
    Heimbach J, Kulik LM, Finn R, et al. AASLD Guidelines for the Treatment of Hepatocellular Carcinoma.

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Northeastern Ohio Medical UniversityYoungstownUSA

Personalised recommendations