Abstract: Objective To assess the value of contrast-enhanced ultrasound (CEUS) with SonoVue in the diagnosis of atypical focal hepatic lesions. Methods A total of 64 patients with liver tumors examined by CEUS using SonoVue in our hospital from March 2016 to March 2019 were selected, including 38 males and 26 females, with an average age of (49.1 ± 10.2) years. A total of 76 atypical focal lesions were diagnosed by imaging examination (MRI and/or CT) or liver histopathology, including 55 malignant lesions (32 primary hepatocellular carcinomas, 6 primary intrahepatic cholangiocarcinomas and 17 metastatic liver cancers) and 21 benign lesions (14 hepatic hemangiomas, 5 focal nodular hyperplasias and 2 hepatic abscesses), with the diameter ranging from 1.9 cm to 7.6 cm. The measurement data were expressed as (±s), compared by t test, and the count data were expressed as absolute values and compared by chi-square test. Results In CEUS, the initial enhancement time of malignant atypical liver focal lesions [(17.2 ± 3.3) s] was significantly earlier than that of benign focal lesions [(26.8 ± 6.7) s, P<0.05]. The initial enhancement washout time of malignant focal lesions [(77.8 ± 12.7) s] was significantly earlier than that of benign focal lesions [(228.4 ± 29.4) s, P<0.05]. The enhancement duration of malignant focal lesions [(43.6 ± 9.3) s] was significantly shorter than that of benign focal lesions [(172.1 ± 22.7) s, P<0.05]. There was no significant difference in the enhancement rate or washout rate between primary and metastatic liver cancers (P>0.05), but there was significant difference in the enhancement pattern and degree (P<0.05). Conclusion CEUS with SonoVue can accurately distinguish the malignant from benign atypical focal hepatic lesions, and primary from metastatic liver cancers.

Key words: Focal hepatic lesion, Contrast-enhanced ultrasound, SonoVue, Primary liver cancer, Metastatic liver cancer