Table of contents
Contrast-enhanced ultrasound of the liver
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of contrast-enhanced ultrasound of the liver are prepared by our editorial team based on guidelines from the European Federation of Societies for Ultrasound (EFSU 2020).
1
Diagnostic investigations
General indications
As per EFSU 2020 guidelines:
Obtain contrast-enhanced ultrasound in patients with inconclusive findings on CT or MRI.
B
Consider contrast-enhanced ultrasound as first-line contrast imaging modality in patients with renal insufficiency.
B
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Indications for detecting liver malignancies
Indications for characterizing focal liver lesions
Indications for characterizing focal liver lesions in liver cirrhosis
Indications for characterizing portal vein thrombosis
Diagnostic procedures
Indications for guiding biopsy
As per EFSU 2020 guidelines:
Attempt contrast-enhanced ultrasound guidance to biopsy focal liver lesions that are invisible or inconspicuous on B-mode imaging.
A
Consider contrast-enhanced ultrasound guidance for focal liver lesions with potential necrotic areas or if previous biopsy resulted in necrotic material.
C
Therapeutic procedures
Indications for intracavitary use
As per EFSU 2020 guidelines:
Consider obtaining intracavitary contrast-enhanced ultrasound for delineation of the liver abscess cavity and identification of correct drain position and of communication with other structures.
C
Consider obtaining intracavitary contrast-enhanced ultrasound to guide transhepatic biliary interventions.
C
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Indications for use in interventional tumor ablation
Perioperative care
Indications for intraoperative use
As per EFSU 2020 guidelines:
Consider contrast-enhanced intraoperative ultrasound to detect and characterize focal liver lesions not detected at preoperative imaging.
B
Obtain contrast-enhanced intraoperative ultrasound for assessment of the region for resection, where previously a pretreatment colorectal liver metastasis was present but has regressed.
B
Specific circumstances
Indications for use in pediatric patients
As per EFSU 2020 guidelines:
Obtain contrast-enhanced ultrasound for characterizing focal liver lesions in pediatric patients.
B
Obtain contrast-enhanced ultrasound follow-up of traumatic liver injuries in pediatric patients for the assessment of complications, reducing ionizing radiation exposure.
B
Follow-up and surveillance
Quality improvement
Technical considerations: as per EFSU 2020 guidelines, ensure that the user of a contrast-enhanced ultrasound examination reports the type and dose(s) of contrast agent, the enhancement pattern and clinically relevant findings in a written format.
B
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Safety considerations