肝内胆管细胞癌超声造影与增强CT表现的对比研究

目的：对比分析肝内胆管细胞癌（Intrahepatic cholangiocarcinoma,ICC）超声造影（Contrast-enhanced ultrasound,CEUS）与增强CT（Contrast-enhanced computed tomography,CECT）的增强表现。方法：对32例经手术病理或肝穿活检证实为ICC的患者的CEUS和CECT检查资料进行回顾性分析,对比分析两者对ICC的增强程度及模式的不同。结果：CEUS和CECT术前正确诊断ICC的分别为24例（75％）和27例（84％）（P>0.05）,如果综合两者,其准确率达94%。动脉期ICC增强方式与病灶大小有一定关系：直径≤3 cm的ICC病灶6个,其中3个在CEUS和4个在CECT上表现为胃全瘤均匀性高增强;而26个直径>3 cm的病灶在CEUS和CECT上表现为不均匀性增强或环形增强的分别为26个和25个。两种大小的病灶动脉期增强方式的差异有统计学意义（P<0.05）,延迟期CEUS和CECT分别有7个和22个ICC为高增强、25个和10个为低增强,两种大小的病灶门脉期增强方式的差异无统计学意义（P>0.05）,但是CEUS上病灶更多表现为低增强。结论：CEUS和CECT的诊断能力无显著差异,CEUS同CECT一样可用于ICC的定性诊断,两者相互结合可进一步提高ICC的诊断率。动脉期ICC小病灶几乎均为全瘤均匀性高增强,而大病灶倾向于不均匀性增强或环形增强。延迟期CEUS上病灶消退倾向比CECT上明显。     

肝内胆管细胞癌超声造影与增强CT表现的对比研究

目的探讨肝内胆管细胞癌（ICC）超声造影（CEUS）与增强CT（CECT）的增强表现。方法28例患者中28个经病理证实的ICC病灶接受了CEUS和CECT检查。CEUS采用造影剂声诺维和低机械指数实时超声成像技术。CECT采用造影剂优维显和常规双期增强扫描。结果动脉期,ICC在CEUS和CECT上呈高增强者分别有23个（82.1%）和19个（67.9%）,低增强分别为5个（17.9%）和9个（32.1%）（P=0.219）。其中CEUS和CECT表现为周边不规则环状高增强的病灶分别有14个（50.0%）和16个（57.1%）,全瘤高增强者分别有9个（32.1%）和3个（10.7%）（P=0.689）。门脉期,CEUS和CECT分别有1个（3.6%）和9个（32.1%）ICC仍呈高增强,27个（96.4%）和19个（67.9%）为低增强（P=0.008）。CEUS和CECT术前正确诊断的分别为23例（82.1%）和19例（67.9%）（P=0.289）。结论ICC在CEUS和CECT上动脉期表现相仿,但门脉期CEUS上病灶增强消退倾向比CECT上明显。两者诊断能力无显著差异,CEUS可用于定性诊断ICC。     

子宫肌瘤超声造影增强模式的初步研究

目的 采用低机械指数连续实时成像技术研究子宫肌瘤超声造影的增强模式。方法32例子宫肌瘤患者42个病灶接受了超声造影检查，采用对比脉冲序列CPS成像技术，造影剂为Sono Vue。结果 静脉注射Sono Vue，全部病灶均可见强化，并可见包膜样强化，20个子宫肌瘤病灶（47．6％）增强早于肌层；16个病灶（38．1％）增强与肌层同步；6个病灶（14．3％）增强晚于肌层。消退时间均早于肌层，呈缓慢消退。增强形态主要为均匀或不均匀增强，增强程度在动脉期10个病灶（23．8％）增强为高回声，19个病灶（45．2％）增强为等回声，13个病灶（31．0％）增强为低回声；静脉期41个病灶（97．6％）增强低于子宫肌层。结论 子宫肌瘤在各时相的增强模式具有特征性，采用CPS技术造影能实时连续地显示子宫肌瘤的增强特点。     

肝内胆管细胞癌超声造影增强模式探讨

目的分析肝内胆管细胞癌（ICC）的超声造影增强模式,探讨其诊断价值。方法38例ICC患者,共38个病灶,注射超声造影剂SonoVue后分析病灶增强水平与增强方式。结果ICC病灶直径1．7-9．6cm,平均（5．6±2．2）cm。动脉相增强模式：均匀高增强5个,不均匀高增强10个,均匀低增强1个,不均匀低增强13个,环状增强6个,部分增强2个,均匀等增强1个。门脉相：低增强36个,等增强2个。延迟相：38个均表现低增强。14个病灶在注射造影剂45s内开始消退,22个在45～120S消退,2个在120S后消退。结论ICC超声造影表现为动脉相多种增强模式,与病灶大小有一定相关性。     

超声造影诊断肝内胆管细胞癌的价值研究

目的 探讨肝内胆管细胞癌(ICC)的超声造影(CEUS)特征及诊断价值。方法 对病理确诊为ICC 35例患者的42个病灶的常规超声及CEUS进行回顾性分析，探讨常规超声及CEUS特征并评价其诊断准确率。结果 CEUS正确诊断ICC 38个病灶，诊断准确度为90%。(1)18个病灶(43%)常规超声提示周边肝内胆管“蜘蛛征”样增宽。(2)CEUS动脉相表现：a.5个病灶(12%)呈整体均匀性高增强。b.37个病灶(88%)呈整体不均匀性高增强，其中12个病灶(29%)呈环状高增强；6个病灶(14%)呈一过性膨胀性厚环状高增强；19个病灶(45%)呈典型或不典型“鸟巢样”高增强。c.<3 cm的病灶表现多样，其中均匀性高增强、一过性膨胀性厚环状高增强仅见于<3 cm的病灶。d.≥3 cm的病灶呈不均匀高增强，其中典型“鸟巢样”高增强仅见于≥3 cm的病灶。(3)所有病灶均见廓清，<3 cm的病灶多在门脉相廓清而≥3 cm的病灶多在延迟相廓清。结论 CEUS诊断ICC有其特征性表现，具有较高的诊断价值。     

超声造影评价肝恶性肿瘤射频治疗疗效--与常规超声及增强CT比较

目的评价造影增强超声（CEUS）对判断肝恶性肿瘤射频消融疗效的应用价值。方法53例肝恶性肿瘤共71个病灶经射频消融治疗后行CEUS检查，其中原发性肝癌44例59个病灶、转移癌9例12个病灶。全部病灶采用超声造影剂SonoVue团注法行CEUS检查，并与同期常规超声及彩色超声、增强CT检查结果比较。超声仪为Technos DU8并使用CnTI实时超声造影匹配成像技术。结果CEUS观察71个病灶中，54个（76．1％）病灶在造影各时相均未强化，提示肿瘤完全灭活；13个（18．3％）病灶边缘局部动脉期增强，判断有肿瘤残存；4个（5．6％）病灶判断不清。最终诊断依据两种以上影像学检查并结合肿瘤标志物水平、穿刺活检、3个月以上随访进行综合判断。以最终诊断为金标准，CEUS诊断准确性91．5％（65／71），增强CT为93．9％（62／66），常规超声及彩色超声为67．6％（48／71）。CEUS与增强CT在评价肿瘤复发或残留方面的灵敏性、特异性、准确性差异均无显著性意义。结论CEUS可较准确地判断射频消融后肿瘤灭活程度，是评价射频消融疗效的有效方法，可成为肝癌局部治疗随访的重要手段，有较高临床应用价值。     

超声造影在肝内胆管细胞癌诊断中的应用价值北大核心CSCD

目的应用常规超声及超声造影观察肝内胆管细胞癌（intrahepatic cholangiocarcinoma,ICC）的特征性表现,探讨超声造影诊断ICC的临床应用价值。方法回顾性分析我院经病理证实为ICC的患者37例,对照病理类型分析病灶位置、范围、回声、血流等声像图特征以及超声造影灌注模式、各时相的特征性表现。结果37例患者中HBsAg（＋）者占56．76％（21／37）。超声检查显示32例（88．89％）低回声病灶,病理均为中或低分化者,5例（11．12％）高回声病灶对应病理均为高分化}27例（72．97％）边界模糊,10例（27．03％）边界清晰。彩色多普勒显示59．46％（22／37）病灶为无血供,余40．54％（15／37）内测及少许血流信号。超声造影于动脉期环状增强19例（51,35％）,整体条片状高增强6例（16．22％）,无强化12例（32．43％）。37个病灶中,25个病灶（67．57％）所在肝的叶段于动脉早期出现一过性增强,12例（32．43％）未出现一过性增强。在门脉期时,6个病灶（16．22％）内可见少许造影剂灌注,其余病灶内均未见灌注。延迟期37例病灶造影剂均为完全退出,表现为无剂灌注。结论常规超声肝内边界模糊的乏血供病灶,超声造影动脉期环状增强和动脉早期病灶所在肝的叶段出现一过性增强是诊断ICC的重要特征性指标。     

肝内胆管细胞癌超声造影研究

目的 探讨低机械指数实时超声造影技术应用于肝内胆管细胞癌(intrahepatic cholangiocarcinama,ICC)的造影表现及诊断价值.方法 通过常规超声及超声造影技术(contrast enhanced ultrasound,CEUS)对22例患者肝内的29个病灶进行检查,记录病灶二维超声特点,观察超声造影各时相增强特点,并与病理结果进行对照,然后进行统计分析.结果 (1)肝内胆管细胞癌二维超声表现多样.(2)超声造影动脉相共观察到4种增强模式:①动脉相病灶整体高增强(20.69％);②动脉相不均质稍高增强(55.17％);③动脉相呈不均质低增强,中心大部分区域呈无增强,仅见树枝状稀疏血管伸入其中(10.34％);④动脉相呈周边环状高增强(1 3.8％).(3)病灶增强模式与病灶大小关系:长径≤2.5 cm的病灶动脉相多呈整体高增强,＞2.5 cm的病灶则以不均质稍高增强为主(P＜0.000 1).长径≤2.5 cm的病灶门脉相多呈低增强,＞2.5cm者多呈等增强(P＜0.000 1);延迟相:病灶均呈低增强表现.(4)超声造影动脉相高增强部分,病理结果显示其内癌细胞较多,血管较丰富.造影示动脉相浅淡增强或充盈缺损部分,病理表现其成分以纤维组织为主,其内稀疏分布的血管,同时可见灶状坏死.结论 ICC超声造影表现具有一定的特征性,超声造影技术对其诊断具有重要价值.     

肝细胞性肝癌超声造影表现与肿瘤病理分化关系的研究

目的探讨肝细胞性肝癌（HCC）超声造影（CEUS）表现与肿瘤病理分化的关系。方法121个HCC病灶接受了CEUS和病理学检查。CEUS使用造影剂声诺维和对比脉冲序列（CPS）成像技术，组织病理诊断按Edmonson法分类。结果肿瘤分化程度与肿瘤增强变低时间呈线性相关。不同分化程度的肿瘤增强变低的时间及延迟期肿瘤的增强水平均有明显差异（P=0．04、P=0．026），但肿瘤开始增强时间、增强变等时间以及动脉期和门脉期肿瘤的增强水平无明显差异（P=0．26、P=0．33、P=0．23、P=0．58）。结论在CEUS上HCC增强消退的时间与肿瘤分化程度相关。分化好的HCC病灶增强减退较慢，少数病灶门脉期或延迟期仍可呈等或高增强，分化差的肿瘤增强减退较快，绝大多数病灶门脉期或延迟期呈低增强。     

超声造影在诊断肿块型自身免疫性胰腺炎中的临床价值

目的探讨超声造影(CEUS)在肿块型自身免疫性胰腺炎(AIP)术前诊断及鉴别诊断中的价值。方法回顾性对比分析19例肿块型AIP与20例胰腺导管腺癌(PDAC)的CEUS表现。结果所有肿块型AIP病灶在动脉期均表现为整体高增强(n=12,63.16%)或等增强(n=7,36.84%),在延迟期呈高增强(n=8,42.11%)或等增强(n=11,57.89%)。而95.00%(n=19)的PDAC病灶在动脉期静脉期及延迟期均呈低增强(P0.05)。结论超声造影凭借其无创、简便、可多次反复检查等优势,有助于术前诊断及鉴别诊断肿块型AIP,在临床实践中有潜在的应用价值。     

含脂质肝癌超声造影表现与MRI表现的对照研究

目的 总结含脂质肝癌的超声造影表现,并与其MRI表现进行比较。方法2010年7月至2012年12月解放军第三О二医院收治的MRI双回波序列成像提示病灶内含有脂质成分的17例肝细胞癌患者,共17个病灶。其中15例患者经增强MRI和增强CT确诊,另2例患者经手术病理证实。分析其常规超声、超声造影及增强MRI的表现。超声造影与增强MRI诊断结果的一致性采用Kappa分析进行检验。结果本组17个病灶二维超声显示9个病灶呈不均质低回声,5个病灶呈低回声;其中13个病灶边界清晰,4个病灶边界欠清晰;彩色多普勒超声观察11个病灶内部无明显血流信号,5个病灶周边可见血流信号,1个病灶可见丰富血流信号。超声造影动脉期15个病灶快速高增强,1个病灶同步等增强,1个病灶轻度增强;门脉期10个病灶廓清,1个病灶呈同步等增强,1个病灶轻度增强;延迟期16个病灶廓清,1个病灶呈等增强;其中6个病灶内存在斑片状、不规则的三期无增强区域。超声造影诊断符合率为82％（14／17）,MRI诊断符合率为88％（15／17）,两者一致性检验的Kappa值为0．628,超声造影与MRI诊断结果一致性较好。结论含脂质肝癌病灶内部或周边始终可见三期无增强区域;含脂质肝癌超声造影的某些特征对于诊断含脂质肝癌具有一定的参考价值。     

Hypoechoic focal liver lesions: characterization with contrast enhanced ultrasonography

PURPOSE: To evaluate the late sinusoidal phase of contrast enhancement with a 2nd-generation ultrasound contrast enhanced medium in the characterization of hypoechoic focal liver lesions. METHODS: We studied 88 hypoechoic liver lesions (diameter range, 1-18 cm; with 18 lesions 2 cm or less) found on conventional grayscale sonography (US) with contrast-enhanced ultrasonography (CEUS). Final diagnosis was made using contrast enhanced helical CT, contrast enhanced MR, angiography (DSA), and/or histopathic confirmation or clinical imaging follow-up. RESULTS: There were 37/88 benign lesions demonstrated: 17 cavernous hemangiomas, 3 capillary hemangiomas, 11 focal nodular hyperplasias (FNH), 3 focal areas of sparing in hepatic steatosis, 2 adenomas, and 1 intrahepatic necrotic area. Malignant lesions demonstrated included 51/88: 27 hepatocellular carcinomas (HCC) in cirrhosis, 11 metastatic carcinomas, 10 metastatic endocrine tumors, 2 cholangiocellular carcinomas (CCC) and 1 non-Hodgkin's lymphoma (NHL). CEUS characterized 30/37 (81%) benign lesions and 45/51 (88%) malignant lesions. On the basis of the results obtained during the sinusoidal contrast enhanced phase of CEUS, diagnosis of benignancy was possible in 35/37 (95%) of benign liver lesions and diagnosis of malignancy in 49/51 (96%) of malignant liver lesions. The enhancement pattern of 13 small (< or = 2 cm in diameter) hypervascular liver lesions (3 capillary hemangiomas, 2 FNHs, 4 HCCs, 4 metastatic endocrine tumors) was better demonstrated on CEUS than on helical CT. In these cases the hyper vascularization of the lesions shown on CEUS was not confirmed on CT. CONCLUSIONS: CEUS distinguished malignant from benign hypoechoic liver lesions with an accuracy of 95%.     

乳腺硬化性腺病的超声造影表现

正乳腺硬化性腺病是一种同时有腺体增生和间质增生的增殖性病变。因其纤维间质成分的限制、挤压,腺体成分的增生呈现出扭曲的形态,触诊时常表现为质硬、活动度欠佳的肿块[1-2],本病的常规超声表现虽有一定特征,但极易误诊。本组回顾性分析我院乳腺硬化性腺病患者的常规超声和超声造影检查资料,旨在总结其声像图特征,探讨超声造影对其的诊断价值。资料与方法一、临床资料回顾性分析2008年7月至2014年3月我院经病理确诊的     

周围型肝内胆管细胞癌:超声造影与增强CT对照

目的 比较周围型肝内胆管细胞癌(ICC)的CEUS与增强CT特点。方法 回顾性分析经手术及病理证实的30例ICC患者(36个病灶)的CEUS及增强CT表现,采用Kappa一致性检验评估两种检查方法诊断的准确率。结果 CEUS显示36个病灶均为动脉期增强,门静脉期及延迟期回声减弱,呈"快进快出"型。增强CT动脉期图像示36个病灶均强化,28个门静脉期及延迟期持续强化,另8个门静脉期及延迟期强化程度减退。CEUS显示19个病灶(19/36,52.78%)周边部环状增强,17个(17/36,47.22%)整体增强;21个(21/36,58.33%)表现为"树枝样"向内延伸。增强CT显示22个病灶(22/36,61.11%)周边环状强化,其中5个呈分隔样强化;14个(14/36,38.89%)为整体强化。达峰值时,CEUS示23个病灶不均匀增强,13个均匀增强;增强CT示20个病灶不均匀增强,16个均匀增强。以"快进快出"、环状增强和(或)"树枝样"增强作为CEUS诊断ICC的标准,CEUS的诊断准确率为70.00%(21/30);以动脉期"环状强化",门静脉期及延迟期"持续强化"作为CT诊断ICC的标准,增强CT的诊断准确率为73.33%(22/30);Kappa一致性检验显示两种检查方法具有很好的一致性(Kappa值＝0.824)。结论 周围型ICC的CEUS与增强CT表现具有一定特征性;两种方法对于周围型ICC均有较高诊断价值。     

Focal Hypoechoic Tumors of Fatty Liver

Objective. The purpose of this study was to investigate the characteristics of focal hypoechoic tumors of fatty liver using conventional ultrasonography and contrast‐enhanced ultrasonography (CEUS). Methods. Sixty‐four hypoechoic tumors of fatty liver in 52 patients were examined by both conventional ultrasonography and CEUS. Contrast pulse sequencing and a sulfur hexafluoride contrast agent were used for CEUS. The enhancement patterns were evaluated in real time. Results . Hypoechoic tumors of fatty liver showed posterior echo enhancement, including 71.4% (25 of 35) of hemangiomas, 73.3% (11 of 15) of metastases, and 50.0% (3 of 6) of hepatocellular carcinomas (HCCs) on conventional ultrasonography. During the early arterial phase, 62.5% (5 of 8) of focal nodular hyperplasia lesions showed a central spoked wheel enhancement pattern, whereas the remaining 37.5% (3 of 8) showed eccentric spoked wheel enhancement. During the arterial phase, 97.1% (34 of 35) of hemangiomas showed peripheral enhancement and centripetal fill‐in, including ringlike peripheral enhancement (12 of 35), small nodular peripheral enhancement (19 of 35), and massive irregular peripheral enhancement (3 of 35). In total, 76.5% (26 of 34) of hemangiomas were completely filled in. All HCCs showed complete enhancement from 9 to 24 seconds during the arterial phase and began to wash out from 21 to 114 seconds. During the arterial phase, 40.0% (6 of 15) of metastases showed ringlike enhancement; 26.7% (4 of 15) showed slight hyperenhancement; 13.3% (2 of 15) showed hyperenhancement quickly; and the remaining 20.0% (3 of 15) showed heterogeneous hyperenhancement. All metastatic tumors began to wash out from 25 to 40 seconds. In total, 92.2% (59 of 64) of focal hypoechoic tumors of fatty liver were diagnosed as the correct pathologic type with CEUS. Conclusions. With CEUS, characterization of hypoechoic tumors of fatty liver is greatly improved.     

不同病理分型混合型肝癌的超声造影特征分析

目的 探究混合型肝癌（CHC）的临床特点及超声造影特征，并探讨不同病理分型混合型肝癌的超声造影表现差异。方法 回顾性分析经手术病理确诊为CHC患者的临床病理及超声图像，总结其超声造影特点并对不同病理分型CHC的超声造影表现进行比较。结果 灰阶超声上，CHC病灶内部以低回声为主（79.6%），多表现为边界不清、形态不规则的实质性肿块。超声造影上，CHC病灶动脉期增强方式表现为整体均匀增强20例（40.8%），整体不均匀增强23例（46.9%），环状增强6例（12.2%）。53.1%表现为显著消退，32.7%为轻度消退。以HCC成分为主的病灶多表现为整体均匀（57.1%，12/21）或不均匀增强（42.9%，9/21），而以ICC为主要成分的病灶多呈整体不均匀增强（48.0%，12/25）或环状增强（24.0%，6/25）。经典型CHC病灶平均消退时间早于伴干细胞特征型CHC（P0.05），两者其余超声造影表现差异无统计学意义。结论 CHC的超声造影表现与HCC、ICC存在部分相似特点。不同细胞成分CHC病灶超声造影增强模式存在差异，经典型CHC与伴干细胞特征型CHC造影剂消退时间有统计学差异，CHC的超声造影表现与病理特点存在相关性。     

Behavior of Hepatocellular Adenoma on Real‐time Low‐Mechanical Index Contrast‐Enhanced Ultrasonography With a Second‐Generation Contrast Agent

Objective. The purpose of this study was to describe the behavior of histologically proven hepatocellular adenoma (HCA) on low‐mechanical index (MI) contrast‐enhanced ultrasonography (CEUS). Methods. A review of the databases from 4 academic hospitals revealed 18 patients (15 female and 3 male; mean age, 40 years; range, 25–71 years) with 25 histologically proven HCA lesions who were studied with CEUS at a low MI (0.04–0.1). Results. Twenty‐four of 25 lesions (96%; 95% confidence interval [CI], 80.5%–99.3%) showed high‐intensity enhancement, scored as 3 on a scale of 0 to 3, whereas only 1 lesion (4%; 95% CI, 0.7%–19.5%) was scored as 2. The time of peak enhancement ranged between 10 and 19 seconds (average, 13 seconds). All but 1 of the 25 lesions (96%; 95% CI, 80.5%–99.3%) showed early homogeneous and centripetal enhancement during the hepatic arterial phase. No portal venous phase enhancement was observed in any lesion because all showed rapid wash‐out (100%; 95% CI, 86.7%–100%). Twenty lesions (80%; 95% CI, 60.9%–91.1%) were found to be isoechoic to slightly hypoechoic during the portal phase, and 19 (76%; 95% CI, 56.6%–88.5%) were isoechoic to mildly hypoechoic, whereas 7 (24%; 95% CI, 11.5%–43.4%) were hypoechoic during the late phase. Conclusions. Contrast‐enhanced ultrasonography is an effective technique for identifying the microvascular and macrovascular characteristics of HCA. Typically, HCA shows early (10–19 seconds) and centripetal enhancement during the arterial phase and isoechogenicity or mild hypoechogenicity during the portal phase, remaining slightly hypoechoic or isoechoic during the late phase in most cases.     

实时谐波超声造影对肝门胆管癌的诊断价值

目的：探讨实时谐波超声造影对肝门胆管癌的诊断价值。方法：30例病理证实的肝门胆管癌病例，分析病灶的增强时间、增强强度及增强方式，并比较造影前后病灶的清晰显示率。结果：肝门胆管癌平均在17．3s病灶开始增强，25．0s时增强达峰值，64．3s时回声已表现为低于周围肝实质。在门脉期及延迟期分别有50．0％（15／30）及93．3％（28／30）表现为低回声。73．3％（22／30）的病灶增强方式表现为整体增强。造影后，病灶清晰显示率从造影前的23．3％（7／30）提高到93．3％（28／30），差异有统计学意义。结论：实时谐波超声造影可显著提高病灶的清晰显示率，对于指导临床选择手术方式有重要意义。     

Characterization of focal liver lesions using contrast-enhanced sonography with a low mechanical index mode and a sulfur hexafluoride-filled microbubble contrast agent

PURPOSE: To characterize focal liver lesions (FLLs) using real-time contrast-enhancedsonography (CEUS) with a low mechanical index mode and a sulfur hexafluoride-filled microbubble contrast agent. METHODS: CEUS was performed in 190 patients with FLLs, including hepatocellular carcinoma (HCC) (n = 107), liver metastasis (n = 21), intrahepatic cholangiocarcinoma (ICC) (n = 7), liver hemangioma (n = 37), focal nodular hyperplasia (FNH) (n = 11), regenerative nodule (n = 6) and liver lipoma (n = 1). The cadence contrast pulse sequencing technique and the contrast agent SonoVue(R) were used for CEUS examination. The enhancement patterns during the arterial, portal, and late phases were evaluated. RESULTS: HCC showed hyperenhancement in 100 (93.5%) of 107 nodules during the arterial phase and hypoenhancement in 102 (95.3%) during the late phase. Liver metastases showed homogeneous enhancement in 8 of 21 (38.1%) nodules and a peripheral regular rim-like enhancement in 11 of 21 (52.4%) nodules during the arterial phase and marked hypoenhancement in 16 of 21 (76.2%) nodules during the late phase. ICC exhibited irregular rim-like enhancement in 4 of 7 (57.1%) nodules during the arterial phase and hypo-enhancement in 7 of 7 (100%) nodules during the late phase. Hemangioma showed peripheral nodular hyperenhancement, and progressive centripetal enhancement was seen in 35 of 37 (94.6%) lesions during the arterial phase. All 11 cases of FNH exhibited homogeneous hyperenhancement during the arterial phase and hyperenhancement (n = 1) or isoenhancement (n = 9) during the late phase. The sensitivity, specificity, and positive predictive value, respectively, were 88.8%, 89.2%, and 91.3% for HCC; 81%, 100%, and 100% for liver metastasis; 57.1%, 100%, and 100% for ICC; 94.6%, 100%, and 100% for liver hemangioma; and 90.9%, 97.8%, and 71.4% for FNH. CONCLUSIONS: Low-mechanical index CEUS permits real-time, complete assessment of vascularity in FLLs, which in turn facilitates their characterization.