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World J Radiol. Apr 28, 2022; 14(4): 70-81
Published online Apr 28, 2022. doi: 10.4329/wjr.v14.i4.70
Focal liver lesions in cirrhosis: Role of contrast-enhanced ultrasonography
Tommaso Vincenzo Bartolotta, Angelo Randazzo, Eleonora Bruno, Adele Taibbi
Tommaso Vincenzo Bartolotta, Angelo Randazzo, Eleonora Bruno, Adele Taibbi, Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
Tommaso Vincenzo Bartolotta, Department of Radiology, Fondazione Istituto G. Giglio Hospital, Cefalù 90015, Italy
Author contributions: Bartolotta TV, Randazzo A, Bruno E and Taibbi A contributed equally to this work; All authors have read and approved the final manuscript.
Conflict-of-interest statement: Tommaso Vincenzo Bartolotta: Lecturer for Samsung.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tommaso Vincenzo Bartolotta, MD, PhD, Associate Professor, Department of Radiology, University Hospital "Paolo Giaccone", Section of Radiology, Department BiND, Palermo 90127, Italy. tommasovincenzo.bartolotta@unipa.it
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: May 3, 2021
Revised: May 16, 2021
Accepted: April 8, 2022
Article in press: April 8, 2022
Published online: April 28, 2022
Abstract

Contrast-enhanced ultrasound (CEUS) represents a great innovation for the evaluation of focal liver lesions (FLLs). The main advantage of CEUS is the real-time imaging examination and the very low toxicity in patients with renal failure. Liver cirrhosis has been recognized as a major risk factor for the onset of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). HCC in liver cirrhosis develops as the last step of a complex that leads to the gradual transformation from regenerative nodule through dysplastic nodule to HCC. In patients with liver cirrhosis, a surveillance program is recommended consisting of ultrasound (US) for detecting small focal lesions. A wide spectrum of benign and malignant lesions other than HCC may be found in the cirrhotic liver and their differentiation is important to avoid errors in staging diseases that may preclude potentially curative therapies. Several published studies have explored the value of CEUS in liver cirrhosis and they have been shown to have excellent diagnostic and prognostic performances for the evaluation of non-invasive and efficient diagnosis of FLLs in patients at high risk for liver malignancies. The purpose of this article is to describe and discuss CEUS imaging findings of FLLs including HCC and ICC, all of which occur in cirrhotic livers with varying prevalence.

Keywords: Ultrasonography, Contrast-enhanced ultrasound, Liver cirrhosis, Liver neoplasms, Hepatocellular carcinoma, Focal liver lesions

Core Tip: Contrast-enhanced ultrasound (CEUS) represents a breakthrough in the evaluation of focal liver lesions (FLLs). Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs in cirrhotic patients and in their follow-up for an accurate assessment of therapeutic response. After a brief description of the basis of different CEUS techniques, several liver lesions that can be found in the cirrhotic liver including benign, malignant or pseudo-lesions, will be described and discussed on the basis of our experience and literature data.