Contrast enhanced ultrasound (CEUS) in the evaluation of liver metastases

Liver metastases are the most frequent malignancies of the liver. The grayscale sonographic appearance of metastases varies: they can be hypoechoic, hyperechoic, they can present a peripheral halo, they can have an infiltrative or cystic appearance. On contrast enhanced ultrasound (CEUS), in the arterial phase, liver metastases can be hyperenhancing (hypervascular ones) or hypoenhancing (hypovascular ones). All liver metastases present wash-out in the portal and late phases, a typical enhancement pattern. CEUS sensitivity is superior to standard ultrasound for the diagnosis of liver metastases being similar to the one of contrast CT.