Incidental liver lesions: diagnostic value of cadence contrast pulse sequencing (CPS) and SonoVue

The widespread use of modern imaging modalities has led to an increase in the frequency of detecting coincidental focal liver lesions (cysts, haemangiomas, focal nodular hyperplasia, adenoma, focal fatty sparing and infiltration) in patients with no symptoms of liver disease. A positive diagnosis is needed to avoid overinvestigation or protracted follow-up. The limitations of conventional sonography have led to the use of other imaging modalities and invasive or costly procedures such as CT, MRI or biopsy. The availability of real-time contrast-enhanced ultrasound imaging (CEUS) has changed the strategy in the characterization of such lesions without inconvenience for the patient. Cadence contrast pulse sequencing (CPS) gives strong contrast signals as well as simultaneous acquisition of conventional scans for a perfect match of these two images. In our personal experience, in comparison with reference imaging, CPS with SonoVue has differentiated benign from malignant lesions in all cases and has accurately characterized 96% of lesions. These results are slightly better than those reported in the literature, probably because of the higher sensitivity of CPS in detecting bubbles, whether flowing or stationary, and also because of the possibility of matching simultaneously recorded contrast and conventional images which reinforces confidence in lesion assessment. The high diagnostic value of CEUS makes this method a candidate to be considered a reference imaging modality for incidental lesions.