[New developments in ultrasound imaging for chronic liver diseases: from anatomic imaging to structural and...

Conventional US imaging is playing a key role for the diagnosis and the therapeutic management of chronic liver diseases. Nevertheless, conventional US imaging is facing many limitations: operator-dependency, subjective assessment, variable detectability of nodules depending on accessibility to the US beam and spontaneous contrast to surrounding normal parenchyma, limited characterization capabilities. Conventional US imaging is taking advantage of major technological improvements including contrast-enhanced US (CEUS), elastography and volume and fusion imaging techniques. CEUS allows real-time detection of contrast enhancement and improves identification of the hypervascular pattern, major diagnostic criteria of hepatocellular carcinoma. Its kinetics is different from those of benign lesions (regenerative nodules, hemangioma…). CEUS is an excellent technique for focal liver lesion characterization (lesion detected previously at either conventional US or any imaging modality) while its performance remains limited for HCC detection. US contrast agent tolerance is excellent is routine clinical practise with no contraindication related to liver or renal dysfunction. US elastography is a non invasive technique that allows detection and quantification of liver fibrosis and is extending its application toward characterization of focal liver diseases. Volumetric and fusion imaging should improve the therapeutic management of malignant liver lesions and particularly percutaneous guidance of thermo-ablation procedures.