Significance of Contrast Enhanced Ultrasound of the Liver

For more than 20 years, contrast-enhanced ultrasound (CEUS) has been an important tool in the imaging of liver tumors, enabling detection and differentiation of the most relevant hepatic lesions with high sensitivity and specificity. Its applications include: immediate characterization of incidentally detected focal liver lesions, assessment of the number and extent of liver metastases in patients with known malignancy, and more detailed evaluation of the liver in chronic liver diseases such as cirrhosis. CEUS of the liver also supports invasive diagnostic and therapeutic procedures and allows immediate assessment of treatment success as well as visualization of potential complications. These diagnostic and interventional applications can be performed both percutaneously and intraoperatively. Another important indication is post-therapeutic follow-up imaging for the evaluation of complications or possible tumor recurrence. The key advantages of contrast-enhanced ultrasound (CEUS) of the liver include - when performed by experienced operators - its rapid and cost-efficient availability, its flexible use at the bedside and intraoperatively, and its favorable safety profile. CEUS can be applied in patients with impaired renal function, thyroid disorders, and in those with contraindications to iodinated or MR contrast agents, and does not involve exposure to ionizing radiation. Thus, CEUS represents a valuable adjunct to CT and MRI, but does not replace them in oncologic staging. The aim of this article is to provide a comprehensive overview of the routine clinical applications of contrast-enhanced ultrasound of the liver illustrated by examples from our institute.

· CEUS is a guideline-recommended standard modality for the characterization of focal liver lesions in the non-cirrhotic liver.. · When used intraoperatively, CEUS allows adjustment of resection margins.. · CEUS is highly suitable and practical for treatment response assessment and follow-up after RFA, MWA, IRE and TACE.. · CEUS is particularly valuable in patients with contraindications to iodinated or MR contrast agents and in those with impaired renal function.. · Key limitations include image quality, operator dependence and a limited field of view..

· Ybinger T, Matic V, Gruenberger T et al. Significance of Contrast Enhanced Ultrasound of the Liver. Rofo 2026; DOI 10.1055/a-2869-9100.