Editorial
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World J Gastroenterol. Jun 7, 2013; 19(21): 3173-3188
Published online Jun 7, 2013. doi: 10.3748/wjg.v19.i21.3173
Fortuitously discovered liver lesions
Christoph F Dietrich, Malay Sharma, Robert N Gibson, Dagmar Schreiber-Dietrich, Christian Jenssen
Christoph F Dietrich, Department of Internal Medicine, Caritas-Krankenhaus Bad Mergentheim, 97980 Bad Mergentheim, Germany
Malay Sharma, Department of Gastroenterology, Jaswantrai Speciality Hospital, Opposite Sports Stadium, Meerut UP 250001, India
Robert N Gibson, Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Victoria 3050, Australia
Dagmar Schreiber-Dietrich, Department of Pediatrics, Asklepiosklinik St. Augustin, Abt. Neonatologie und Pädiatrische Intensivmedizin, 52757 Augustin, Germany
Christian Jenssen, Klinik für Innere Medizin, Krankenhaus Märkisch Oderland, 15334 Strausberg, Germany
Author contributions: Dietrich CF and Jenssen C established the design and conception of the paper; Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D and Jenssen C analyzed the literature data; Dietrich CF provided the first draft of the manuscript, which was discussed and revised critically for intellectual content by Sharma M, Gibson RN, Schreiber-Dietrich D and Jenssen C; Dietrich CF, Gibson RN and Jenssen C provided figures; Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D and Jenssen C discussed the statement and conclusions, the comments of the reviewer, and approved the final version to be published.
Correspondence to: Christoph F Dietrich, Professor of Medicine, Department of Internal Medicine, Caritas-Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Germany. christoph.dietrich@ckbm.de
Telephone: +49-7931-582201 Fax: +49-7931-582290
Received: December 25, 2012
Revised: March 22, 2013
Accepted: April 27, 2013
Published online: June 7, 2013
Abstract

The fortuitously discovered liver lesion is a common problem. Consensus might be expected in terms of its work-up, and yet there is none. This stems in part from the fact that there is no preventive campaign involving the early detection of liver tumors other than for patients with known liver cirrhosis and oncological patients. The work-up (detection and differential diagnosis) of liver tumors comprises theoretical considerations, history, physical examination, laboratory tests, standard ultrasound, Doppler ultrasound techniques, contrast-enhanced ultrasound (CEUS), computed tomography and magnetic resonance imaging, as well as image-guided biopsy. CEUS techniques have proved to be the most pertinent method; these techniques became part of the clinical routine about 10 years ago in Europe and Asia and are used for a variety of indications in daily clinical practice. CEUS is in many cases the first and also decisive technical intervention for detecting and characterizing liver tumors. This development is reflected in many CEUS guidelines, e.g., in the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines 2004, 2008 and 2012 as well as the recently published World Federation for Ultrasound in Medicine and Biology-EFSUMB guidelines 2012. This article sets out considerations for making a structured work-up of incidental liver tumors feasible.

Keywords: Contrast-enhanced ultrasound, Hepatocellular carcinoma, Hemangioma, Focal nodular hyperplasia, Metastasis, Ultrasonography, Recommendations, Guidelines

Core tip: The presented paper is intended to discuss, comment and illustrate the recently published international guidelines on hepatic applications of contrast-enhanced ultrasound. Recommendations are based on a prospective multicenter study with more than 1000 histologically confirmed tumors and on national and international guidelines. The focus is on the important clinical work-up of the fortuitously discovered liver lesion. In contrast to most other published papers dealing with imaging methods, these recommendations also give advice for the clinician from a clinical point of view, including laboratory data. The described work-up includes different scenarios, e.g., the asymptomatic (healthy) patient vs the oncological patient. Limitations of techniques and sources of error are also explained.