Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysis



This meta-analysis was performed to evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in differentiating malignant from benign focal liver lesions (FLLs).


Cochrane Library, PubMed and Web of Science databases were systematically searched and checked for studies using CEUS in characterization of FLLs. Data necessary to construct 2×2 contingency tables were extracted from included studies. The QUADAS tool was utilized to assess the methodologic quality of the studies. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias was comprehensively performed.


Fifty-seven studies were included in this meta-analysis and the overall diagnostic accuracy in characterization of FLLs was as follows: pooled sensitivity, 0.92 (95%CI: 0.91–0.93); pooled specificity, 0.87 (95%CI: 0.86–0.88); diagnostic odds ratio, 104.20 (95%CI: 70.42–154.16). Subgroup analysis indicated higher diagnostic accuracy of the second-generation contrast agents (CAs) than the first-generation CA (Levovist; DOR: 118.27 vs. 62.78). Furthermore, Sonazoid demonstrated the highest diagnostic accuracy among three major CAs (SonoVue, Levovist and Sonazoid; DOR: 118.82 vs. 62.78 vs. 227.39). No potential publication bias was observed of the included studies.


CEUS is an accurate tool to stratify the risk of malignancy in FLLs. The second-generation CAs, especially Sonazoid may greatly improve diagnostic performance.

Key Points

CEUS shows excellent diagnostic accuracy in differentiating malignant from benign FLLs.

The second-generation CAs have higher diagnostic accuracy than first-generation CAs.

Sonazoid demonstrates the highest diagnostic accuracy among three major CAs.

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Contrast-enhanced ultrasound


Focal liver lesions


Contrast agents


Contrast agent


Quality Assessment of Diagnostic Accuracy Studies


True positive


True negative


False positive


False negative


Diagnostic odds ratio


Positive likelihood ratio


Negative likelihood ratio


Confidence intervals


Hierarchical summary receiver operating characteristic


Area under the curve


Relative diagnostic odds ratio


Upper limit


Lower limit


Hepatocellular carcinomas


Reticuloendothelial system


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This study has received funding by the Youth Science Foundation of the Second Hospital Center Laboratory of Tianjin Medical University (2016YDEY01), Science Foundation of Tianjin Medical University (2016KYZQ06 and 2014KYM15), Foundation of Tianjin Health and Family Planning Commission (16KG115).

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Correspondence to Xue Li or Xuening Zhang.

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The scientific guarantor of this publication is Xuening Zhang.

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Written informed consent was not required for this study because the study concerns a meta-analysis.

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Institutional review board approval was not required because the study concerns a meta-analysis.


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Menglin Wu and Liang Li are co-first authors.

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Wu, M., Li, L., Wang, J. et al. Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysis. Eur Radiol 28, 2077–2088 (2018).

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  • Ultrasonography
  • Contrast media
  • Liver neoplasms
  • Diagnosis
  • Meta-analysis