Detecting and characterizing focal liver lesions is one of the most difficult challenges in imaging today. All standard noninvasive imaging modalities are less sensitive than generally perceived, and characterization is imperfect. Liver sonography’s main strengths are its ability to definitively characterize common benign lesions (eg, cysts and hemangiomas), safety, low cost, and its ability to guide biopsy. Sonography’s weaknesses include its inability to image the entire liver in many patients and its inferiority to CT as a means of detecting extrahepatic malignant disease. Sonography is less sensitive than CT or MRI in detecting focal lesions. Ultrasound contrast agents will certainly improve liver lesion detection and characterization, but their impact is not yet clear.
Typical findings in common focal liver lesions are discussed, and some hints to improve sonographic diagnosis are presented. Increased color Doppler flow should bring the possibility of hepatocellular carcinoma and focal nodular hyperplasia to mind, but Doppler diagnosis is ultimately not highly specific. Sonography, including Doppler analysis, is useful to assess the resectability of malignant masses. Intraoperative ultrasound is the most sensitive imaging modality in detecting focal liver lesions.