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April 12, 2021 — European Journal of Ultrasound


By Prof. Deike Strobel

Friedrich-Alexander Universitat, Medizinische Klinik 1, Erlangen-Nurnberg, Deutschland

Read full text at: DOI: 10.1055/a-1347-1388; Ultraschall in der Medizin – European Journal of Ultrasound 2021; 42(02): 120 – 124


The initial applications of contrast-enhanced ultrasound to the diagnosis of liver tumors were employed more than 30 years ago in Germany. Initially intended for enhanced imaging of liver metastases, contrast-enhanced ultrasonography evolved into an ideal technique for characterizing focal liver lesions.

The introduction of stable contrast agents (SonoVue) and low-MI imaging technology in 2001 marked the breakthrough for widespread clinical use in Europe. Important pioneering work by individual research groups on contrast-enhanced sonographic tumor vascularization patterns was followed in 2008 by the first prospective DEGUM multicenter study with 1349 patients, which demonstrated a greater than 90 % diagnostic accuracy of contrast-enhanced sonography when differentiating B-scan-morphologically unclear hepatic lesions compared to histologically-verified masses.

Numerous European multicenter studies have confirmed the high diagnostic value of contrast-enhanced ultrasonography, also in comparison to CT and MRI. Meta-analyses followed, including that of M. Friedrich-Rust in 2013, which demonstrated excellent diagnostic accuracy of contrast-enhanced sonography in differentiating benign and malignant liver lesions in 7231 focal liver lesions, with a sensitivity of 93 % (range 91–95 %) and a specificity of 90 % (range 88–93 %) [8]. The high value of contrast-enhanced sonography was shown when compared to MRT and CT, and also with respect to small hepatic lesions as a problem solver in focal findings which due to their tiny size cannot be classified with certainty using CT or MRI.

Contrast-enhanced sonography rightly occupies a firm position in liver tumor diagnostics. It is a cost-effective method, safe to use, and for many patients shortens the path through diagnostic processes.

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