Application of real-time three-dimensional contrast-enhanced ultrasound using SonoVue for the evaluation of focal liver lesions: a prospective single-center study.

Focal liver lesions (FLLs) include a variety of benign and malignant tumors, and are usually differential diagnosed by ultrasonography. However, traditional two-dimensional contrast-enhanced ultrasound (2D-CEUS) can evaluate a single slice of a lesion. It cannot fully display perfusion of a lesion and the relationship with the surrounding tissues, which may lead to misdiagnosis. This study aimed to investigate real-time three-dimensional CEUS (3D-CEUS) for evaluation of the vascular configuration of FLLs. Using real-time 3D-CEUS with SonoVue on 161 patients with FLLs, we found that when compared with 2D-CEUS, real-time 3D-CEUS provided more detailed information about the origin, continuity, and numbers and structures of the feeding artery. On 3D-CEUS hepatocellular carcinoma showed intratumoral vessels with diffuse enhancement, metastatic liver cancer showed peritumoral vessels or absence of tumor vessels with ring-like enhancement or non-enhancement, focal nodular hyperplasia showed a spoke-wheel artery with diffuse enhancement, and hemangiomas showed nodular enhancement. Our results demonstrate that real-time 3D-CEUS using SonoVue is an effective method for visualizing the characteristic vascular configuration of FLLs, and this may assist with the diagnosis.