Algorithm‐based approach to focal liver lesions in contrast‐enhanced ultrasound

Abstract

Focal liver lesions are commonly encountered. Grey‐scale and Doppler sonographic characteristics of focal liver lesions are often non‐specific and insufficient to conclusively characterise lesions as benign or malignant. Contrast‐enhanced ultrasound is useful for the characterisation of FLLs in patients who are unable to undergo contrast‐enhanced computed tomography or magnetic resonance imaging. It is also easily available and relatively cheap. However, interpretation of contrast‐enhanced ultrasound can be challenging without a systematic approach. In this pictorial essay, we highlight an algorithm‐based approach to FLLs and discuss the characteristic contrast‐enhanced ultrasound features of commonly encountered and clinically significant focal liver lesions.

Comprehensive review of imaging modalities for diagnosis and characterization of focal liver lesions

“…In terms of enhancement patterns, HCCs typically show hyperintensity in arterial phase of T1-weighted sequences, and appear somewhat hypointense in the portal and delayed phases. However, contrast enhancement of hemangioma is characterized by peripheral enhancement in the early arterial phase is nodular, followed by gradual centripetal filling in the portal venous and delayed phases [5] . The classic enhancement appearance of FNH includes an intensely enhancing lesion in the arterial phase with a centrally located fibrous scar.…”

“…For instance, focal nodular hyperplasia (FNH), hepatic haemangioma, hepatic cysts, and hepatocellular adenoma [4] . To reach a definitive diagnosis, various approaches are used, including: conventional ultrasound (US), contrast enhanced ultrasound (CEUS), contrast enhanced computed tomography (CT) and contrast enhanced magnetic resonance imaging (MRI) [5] . However, due to the lack of guidelines, the majority of organizations resort to using all the obtainable techniques to confirm a diagnosis.…”

“…However, due to the lack of guidelines, the majority of organizations resort to using all the obtainable techniques to confirm a diagnosis. This approach is not only inconvenient and time-consuming but also expensive [5,6] .…”