Contrast-enhanced ultrasound (CEUS) combines the real time scanning benefits and higher spatial and temporal resolution of B mode ultrasound with the tumour-differentiation and tumour-specification utilities of purely intravascular/blood pool ultrasound contrast agents (UCAs). It does not bear the spectre of nephrotoxicity or radiation exposure and its attendant risks and hazards that computed tomography (CT) comes with, nor is it time-consuming as in magnetic resonance imaging (MRI) studies. However, CEUS is still not used often enough for various reasons even though it is well tolerated. Given...

B-mode and Doppler examination should precede any CEUS procedure to localise and quantify the liver lesions. It is mandatory to peruse the patient’s medical history and previous images if any. A dual-screen display allows both the contrast and B-mode images to be examined at the same time. [1] Once the patient is comfortably positioned and the lesion is maintained at a distance of < 10 cm from the transducer, the contrast bolus is injected intravenously and followed by a saline flush.[1] The timer is started...

The study sample included 36 subjects (28 males and 8 females). The mean age was 58.89 years ranging from 26 to 89 years. The study sample can be divided into a subsample A (with histopathology as the diagnostic gold standard) and subsample B (without histopathology; here CT/MRI has been considered as the diagnostic gold standard). Subsample A comprised 30 patients with histopathology with the following diagnoses: hepatocellular carcinoma, cholangiocarcinoma, metastases, adenoma and abscess (Fig 9). Subsample B consisted of haemangioma, regenerative nodule, granuloma and hamartoma....

1. CEUS and MRI are equallyhelpfulto differentiate between newly discovered solid liver tumours detected on routine B mode ultrasound. 2. CEUS can be done in the same sitting as that of the routine B scan, when a previously unknown liver lesion is noted on the B mode ultrasound and appears atypical. This approach is rational and time saving in providing patients with a definitive diagnosis thusalleviatingthe associated and unnecessary "tumour anxiety". 3. When performed by an experienced operator, CEUS can significantly decrease the expenditure incurred...

Dr. S. Ghosh, MBBS is radiologist-in-training andthe principal investigator in this study, havingreceived sponsorship for the same from the Medical Research wing of PD Hinduja National Hospital & MRC, Mumbai, India; Dr. R. J. Balsarkar, MBBS, DMRD, DNB is Consultant Sonologist at PD Hinduja National Hospital & MRC, Mumbai, India and co-authorof this paper.

1. Claudon M, Dietrich CF, Choi BI, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver: update 2012—a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013; 34:11–29 2. Barnett SB, Duck F, Ziskin M. Recommendations on the safe use of ultrasound contrast agents. Ultrasound Med Biol 2007;33:173-174 3. Dietrich CF, Ignee A, Hocke M, Schreiber-Dietrich D, Greis C. Pitfalls and artefacts using contrast enhanced ultrasound. Z Gastroenterol 2011;49:350-356 4. Seitz...