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Abstract
Abdominal ultrasound is one of the most popular imaging methods due to its feasibility, low cost and accessibility. Contrast Enhanced Ultrasound (CEUS) with second generation contrast agents became in the last years a useful tool for the characterization of focal liver lesions (FLL) so that EFSUMB issued guidelines for its use in clinical practice. Several large studies proved that CEUS has similar performance to more expensive imaging methods such as contrast enhanced CT and contrast enhanced MRI for the characterization of FLL. Also, several studies proved that CEUS is cost-effective as a first-line imaging method. Considering all these data, we think that CEUS is ready to be used in daily practice for the evaluation of FLL.
Keywords: contrast enhanced ultrasound, focal liver lesions, clinical practice, cost-effective
Abdominal ultrasound became the most popular imaging method due to its feasibility, low cost and accessibility. Ultrasound machines are better every day, a lot of image improvements becoming available in most devices (color Doppler, Power Doppler, or THI). Regarding the individuals who should perform ultrasound, they can be either radiologists (practice more common in Anglo- Saxon countries), or clinicians (gastroenterologists, urologists, internal medicine specialists, etc). Clinical ultrasound or "point of care" ultrasound [1] is a common practice for a long time in a part of Europe (Germany, Italy or Romania) and was recently "rediscovered" in the United States [2].
Since such a huge number of abdominal ultrasound examinations are performed in daily practice (either by clinicians or by radiologists), during which the liver structure should always be evaluated, a large number of focal liver lesions (FLL) are discovered. Some of them are the so called "incidentalomas" (incidental discovered lesions in asymptomatic subjects); others are lesions in patients known with chronic diseases (liver cirrhosis or oncologic patients). But, even if standard (grey scale) ultrasound is a sensitive method for the visualization of such lesions, it has low accuracy for their characterization.
In the last period, the use of Contrast Enhanced Ultrasound (CEUS) with second generation contrast agents ("bubbles") became a useful tool for the characterization of FLL. The evaluation time with CEUS is 4-5 minutes, and the conclusion can be drawn immediately after the examination. In 2004 the European Federation of Societies for Ultrasound in Medicine and...