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Wilson et al. Hepatoma Res 2020;6:57 Hepatoma Research
DOI: 10.20517/2394-5079.2020.48

Review Open Access

Contrast-enhanced ultrasound of focal liver masses

Stephanie R. Wilson , Christina Merrill 2
1
1 Department of Radiology, University of Calgary, Calgary T2N 2T9, Canada.
2 Department of Radiology, Foothills Medical Centre, Calgary T2N 2T9, Canada.

Correspondence to: Prof. Stephanie R. Wilson, Department of Radiology, University of Calgary, 1403 29 Street NW, Calgary T2N
2T9, Canada. E-mail: stephanie.wilson@ahs.ca

How to cite this article: Wilson SR, Merrill C. Contrast-enhanced ultrasound of focal liver masses. Hepatoma Res 2020;6:57.
http://dx.doi.org/10.20517/2394-5079.2020.48

Received: 4 May 2020 First Decision: 3 Jun 2020 Revised: 22 Jun 2020 Accepted: 6 Jul 2020 Published: 1 Sep 2020
Academic Editor: Yuko Kono Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Non-invasive imaging is the current method of choice for the characterization of frequently discovered focal liver
disease. Although historically, contrast-enhanced computed tomography (CT) and magnetic resonance (MR)
Received: First Decision: Revised: Accepted: Published: scans have been selected for this purpose, contrast-enhanced ultrasound (CEUS) now offers a less expensive
and safer method to acquire the same information. Performed with the intravenous injection of a microbubble
Science Editor: Copy Editor: Production Editor: Jing Yu
contrast agent, CEUS provides some unique advantages that make it a valuable addition to an imaging toolbox.
CEUS is performed in dynamic real-time, providing superior temporal resolution compared to other modalities
and allowing detection of enhancement regardless of its timing or duration. CEUS is performed with a purely
intravascular contrast agent, providing accurate depiction of the presence of microbubbles in the circulation in
all phases of imaging. This compares with CT and MR contrast agents, which have a well-recognized interstitial
phase. Resulting discordant imaging may occur especially in the portal venous phase, when CT and MR may
show pseudoenhancement from interstitial contrast, while CEUS will accurately show washout in malignant
tumors. Lastly, the contrast specific software used to perform CEUS has an excellent subtraction technique, which
produces a contrast only image with high sensitivity to enhancement in thin septations and small nodules. CEUS
makes a positive contribution to liver mass characterization in any situation.

Keywords: Contrast-enhanced ultrasound, liver, cancer, diagnosis

INTRODUCTION
Focal liver masses are a frequent occurrence and reflect a wide spectrum of histology ranging from
benign and totally insignificant tumors to life-threatening malignancies. Incidental discovery on imaging,

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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