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

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.