Contrast ultrasound imaging in liver disease

The recent introduction of high-end ultrasound equipments combined with the introduction of contrast agents provides marked improvements in liver imaging for the detection and the characterization of focal lesions. Previous imaging methods were based on high acoustic power and demonstrated improved detection of focal liver lesions. However, good and reliable results were difficult to achieve due to limited number of sweeps, as most of the microbubbles were destroyed within one pass. Non linear imaging methods at low acoustic power allowed great advances in the characterization by limiting signal from background tissue as well as agent collapse allowing continuous imaging starting from the time of contrast injection until complete disappearance of the agent. Contrast-enhanced imaging of the liver follows conventional sonography performed with high standards for detection and localization of lesions using multiple sweeps. Then targeted acquisition is performed for specific lesion characterization after a second contrast injection. Interpretation is based on the presence or not of microbubbles within the lesion (hyper-, hypo- or isosignal) and the delay from injection (arterial, portal or parenchymal or late phase). A well-recognized semiology is reported in this paper. Based on these criteria, sensitivity and specificity are close to those reported with other modalities with accuracy 85-95% for focal liver lesions and 75% for hepatocellular carcinomas. Those results markedly improve ultrasound accuracy compared to conventional sonography, and so put contrast-enhanced sonography among recommended non-invasive imaging methods for focal liver lesions with changes in diagnostic strategy.