The role of real-time contrast-enhanced and real-time virtual sonography in the assessment of malignant liver lesions.

Contrast enhanced ultrasound has recently been introduced and is recommended in daily practice in many circumstances, mainly for the detection and characterization of focal liver lesions. Also, contrast enhanced ultrasound has the potential of becoming the primary liver-imaging modality, preceding CT or MR, for the diagnosis of hepatocellular carcinoma in patients with cirrhosis, detection of liver metastases in oncology patients and guidance and assessment of the outcome of percutaneous tumor ablation procedure. Recently, a new imaging technique that combines in real-time, transabdominal ultrasound with CT or MR, has been introduced in clinical practice. Real-time virtual sonography uses a magnetic positioning system attached to the ultrasound probe in order to calculate the spatial position and to display both imaging methods in real-time. Benefits include an increased diagnostic confidence, direct comparison of the lesions using different imaging modalities, more precise monitoring of interventional procedures and reduced radiation exposure. We describe the role of real-time contrast-enhanced and real-time virtual sonography in the assessment of malignant liver lesions.