The routine use of contrast enhanced ultrasound in the imaging work-up of focal liver lesions: A proposed algorithm

Background: Grey scale ultrasound study of the liver is frequently performed for routine health screening or surveillance of high-risk patients. Our institution performs an average of 15000 ultrasound liver examinations a year. Focal liver lesions (FLL) are detected in about 10 – 15% of these patients, requiring further work up. Contrast enhanced ultrasound (CEUS) is now a widely accepted imaging technique for characterization of liver lesions. However, they are considered less established when compared to CT or MRI imaging. While various guidelines on its use in liver imaging have been published, some recommend…