CEUS for Liver Tumors

1. Introduction to CEUS 100%

CEUS = Contrast-Enhanced Ultrasound
Involves real-time liver perfusion using microbubble contrast
No ionizing radiation or nephrotoxicity
Especially useful in cirrhosis, focal liver lesions, or contrast contraindications

2. Technique and Phases 100%

IV bolus of contrast agent (e.g., SonoVue)
Scanning in 3 major phases:
– Arterial (10–30 sec)
– Portal Venous (30–120 sec)
– Late (>120 sec to 4–6 min)
Real-time evaluation of enhancement and washout patterns

3. CEUS Patterns of Liver Tumors 100%

1. Benign Lesions

Hemangioma – Peripheral nodular enhancement with centripetal fill-in, no washout
FNH (Focal Nodular Hyperplasia) – Spoke-wheel arterial pattern, iso/hyper in late phase
Regenerative Nodules – Isoenhancement in all phases, no washout

2. Malignant Lesions

HCC (Hepatocellular Carcinoma) – Arterial hyperenhancement, mild late washout
Metastases – Rim or heterogeneous enhancement, early and marked washout
Cholangiocarcinoma – Rim enhancement, early intense washout
Lymphoma – Hypoenhancing or rim-enhancing, washout variable

4. Clinical Applications 90%

Characterization of indeterminate liver lesions
Differentiation between benign and malignant nodules
Diagnosis of small HCCs in cirrhotic livers
Follow-up after local therapies (e.g., RFA, TACE)
Alternative when CT/MRI is contraindicated

5. Advantages and Limitations 100%

Advantages

Real-time, bedside imaging
No radiation or nephrotoxicity
Dynamic perfusion assessment
Repeatable and safe

Limitations

Operator dependency
Limited field of view (compared to CT/MRI)
Difficult in obese or gassy patients
Less effective in multifocal or deep lesions

6. Case Studies and Quiz Section 0%

CEUS patterns: HCC vs Hemangioma vs Metastasis
Quiz: Match CEUS phases with correct lesion diagnosis
Image-based lesion interpretation
Case review of CEUS in cirrhotic liver