ObjectivesIn high‐BMI patients with and without fatty liver, we evaluate performance of a commercially available specially designed ultrasound probe (SDP) for scanning at depth. Greyscale and contrast‐enhanced ultrasound (CEUS) capability of SDP for parenchymal assessment and liver mass characterization, emphasizing HCC, is compared with standard curvilinear probes.MethodsThis retrospective study included 60 patients. Fifty‐five with measured BMI included 46/55 (84%) overweight or obese, and 9/55(16%) in the normal range with severe fatty liver. Fifty‐six patients with focal liver abnormality included 37 with a mass and 19 with post‐ablative treatment site. Masses included 23 confirmed malignancies, 15 HCC, 4 ICC, and 4 metastases. SDP followed suboptimal ultrasound using a standard probe. Images with varying fat content were compared for depth of penetration on greyscale and ability of CEUS to diagnose tumors.ResultsSDP showed statistically significant improvement P = <.05 in CEUS penetration for all degrees of fatty liver (mild, moderate, and severe). In malignant tumors, SDP improved detection of lesion washout in the portal venous/late phase (PVP/LP) at depth >10 cm, and in all malignant masses (P < .05).Fifteen confirmed deep HCC showed arterial phase hyperenhancement on standard probe in 10/15 (67%) and 15/15 (100%) on SDP. PVP/LP washout on standard probe was shown in 4/15 (26%) and on SDP, 14/15, (93%). Therefore, 93% of LR‐5 tumors were diagnosed with SDP. Removing necessity for biopsy.ConclusionsMetabolic syndrome and obesity challenge ultrasound, especially CEUS. SDP overcame limitations of standard probes for CEUS penetration especially in fatty liver. SDP was optimal for the liver mass characterization by detecting washout.

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