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Review article: Medical guidelines

Vol. 153 No. 9 (2023)

Assessment of focal liver lesions in non-cirrhotic liver – expert opinion statement by the Swiss Association for the Study of the Liver and the Swiss Society of Gastroenterology

  • Mikael Sawatzki
  • Daniela B. Husarik
  • David Semela
DOI
https://doi.org/10.57187/smw.2023.40099
Cite this as:
Swiss Med Wkly. 2023;153:40099
Published
12.09.2023

Summary

Focal liver lesions are common, with a prevalence up to 20%. The lesions must be evaluated in context of risk factors associated with malignancy. Risk factors include age >40 years, known current or past malignancy, presence of liver cirrhosis or chronic liver disease (i.e. suspected by elevated liver elastography measurement ≥8 kPa or FIB-4 score ≥1.3), unintentional weight loss, fever or night sweats, newly detected focal liver lesions, documented growth of focal liver lesions, current or past use of androgens (e.g. testosterone, oxymetholone, danazol), increased serum tumour markers (i.e. alpha-fetoprotein, carbohydrate antigen 19-9 [CA19-9], carcinoembryonic antigen [CEA]) and family history of malignancy.

In patients without risk factors of malignancy, regional (non-)fatty changes, simple liver cysts and typical haemangiomas can be diagnosed by conventional ultrasound (without contrast). Conventional ultrasound Doppler is recommended to rule out vascular malformations such as portosystemic shunts.

In all other cases of focal liver lesions, contrast-enhanced imaging is indicated for differentiation in benign and malignant dignity.

Contrast-enhanced ultrasound (CEUS) as a first diagnostic step and contrast-enhanced magnetic resonance imaging (MRI) are accurate tests to diagnose haemangioma and focal nodular hyperplasia.

Hepatocellular adenoma is diagnosed by contrast-enhanced MRI and/or histology.

“Wash out” on CEUS is highly suspicious for a malignant focal liver lesion. Additional investigations aimed at identifying the primary tumour, as well as staging-computed tomography, MRI and/or histology may be necessary and should be decided on a case-by-case basis.

A biopsy of focal liver lesions is indicated in cases of unclear dignity, malignant aspect and focal liver lesions of unclear origin as well as for guiding surgical and oncological management.

References

  1. European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the management of benign liver tumours. J Hepatol. 2016 Aug;65(2):386–98. 10.1016/j.jhep.2016.04.001 DOI: https://doi.org/10.1016/j.jhep.2016.04.001
  2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of cystic liver diseases. J Hepatol. 2022 Oct;77(4):1083–108. 10.1016/j.jhep.2022.06.002 DOI: https://doi.org/10.1016/j.jhep.2022.06.002
  3. Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver — update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med. 2013 Feb;34(1):11–29.
  4. Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, et al. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol. 2020 Oct;46(10):2579–604. 10.1016/j.ultrasmedbio.2020.04.030 DOI: https://doi.org/10.1016/j.ultrasmedbio.2020.08.015
  5. Chernyak V, Horowitz JM, Kamel IR, Arif-Tiwari H, Bashir MR, Cash BD, et al.; Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria® Liver Lesion-Initial Characterization. J Am Coll Radiol. 2020 Nov;17(11S 11s):S429–46. 10.1016/j.jacr.2020.09.005 DOI: https://doi.org/10.1016/j.jacr.2020.09.005
  6. Smith-Bindman R, Miglioretti DL, Johnson E, Lee C, Feigelson HS, Flynn M, et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA. 2012 Jun;307(22):2400–9. 10.1001/jama.2012.5960 DOI: https://doi.org/10.1001/jama.2012.5960
  7. Goossens N, Toso C, Heim MH. Management of hepatocellular carcinoma: SASL expert opinion statement. Swiss Med Wkly. 2020 Jul;150(3132):w20296. 10.4414/smw.2020.20296 DOI: https://doi.org/10.4414/smw.2020.20296
  8. Horta G, López M, Dotte A, Cordero J, Chesta C, Castro A, et al. [Benign focal liver lesions detected by computed tomography: review of 1,184 examinations]. Rev Med Chil. 2015 Feb;143(2):197–202. 10.4067/S0034-98872015000200007 DOI: https://doi.org/10.4067/S0034-98872015000200007
  9. Rawla P, Sunkara T, Muralidharan P, Raj JP. An updated review of cystic hepatic lesions. Clin Exp Hepatol. 2019 Mar;5(1):22–9. 10.5114/ceh.2019.83153 DOI: https://doi.org/10.5114/ceh.2019.83153
  10. Bahirwani R, Reddy KR. Review article: the evaluation of solitary liver masses. Aliment Pharmacol Ther. 2008 Oct;28(8):953–65. 10.1111/j.1365-2036.2008.03805.x DOI: https://doi.org/10.1111/j.1365-2036.2008.03805.x
  11. Gore RM, Pickhardt PJ, Mortele KJ, Fishman EK, Horowitz JM, Fimmel CJ, et al. Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017 Nov;14(11):1429–37. 10.1016/j.jacr.2017.07.018 DOI: https://doi.org/10.1016/j.jacr.2017.07.018
  12. Kaltenbach TE, Engler P, Kratzer W, Oeztuerk S, Seufferlein T, Haenle MM, et al. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Abdom Radiol (NY). 2016 Jan;41(1):25–32. 10.1007/s00261-015-0605-7 DOI: https://doi.org/10.1007/s00261-015-0605-7
  13. McLin VA, Franchi Abella S, Debray D, Guérin F, Beghetti M, Savale L, et al.; Members of the International Registry of Congenital Porto-Systemic Shunts. Congenital Portosystemic Shunts: Current Diagnosis and Management. J Pediatr Gastroenterol Nutr. 2019 May;68(5):615–22. 10.1097/MPG.0000000000002263 DOI: https://doi.org/10.1097/MPG.0000000000002263
  14. Dietrich CF, Averkiou M, Nielsen MB, Barr RG, Burns PN, Calliada F, et al. How to perform Contrast-Enhanced Ultrasound (CEUS). Ultrasound Int Open. 2018 Jan;4(1):E2–15. 10.1055/s-0043-123931 DOI: https://doi.org/10.1055/s-0043-123931
  15. Westwood M, Joore M, Grutters J, Redekop K, Armstrong N, Lee K, et al. Contrast-enhanced ultrasound using SonoVue® (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2013 Apr;17(16):1–243. 10.3310/hta17090 DOI: https://doi.org/10.3310/hta17160
  16. Piscaglia F, Bolondi L; Italian Society for Ultrasound in Medicine and Biology (SIUMB) Study Group on Ultrasound Contrast Agents. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol. 2006 Sep;32(9):1369–75. 10.1016/j.ultrasmedbio.2006.05.031 DOI: https://doi.org/10.1016/j.ultrasmedbio.2006.05.031
  17. Jang JY, Kim MY, Jeong SW, Kim TY, Kim SU, Lee SH, et al. Current consensus and guidelines of contrast enhanced ultrasound for the characterization of focal liver lesions. Clin Mol Hepatol. 2013 Mar;19(1):1–16. 10.3350/cmh.2013.19.1.1 DOI: https://doi.org/10.3350/cmh.2013.19.1.1
  18. Schwarze V, Marschner C, Negrão de Figueiredo G, Rübenthaler J, Clevert DA. Single-Center Study: Evaluating the Diagnostic Performance and Safety of Contrast-Enhanced Ultrasound (CEUS) in Pregnant Women to Assess Hepatic Lesions. Ultraschall Med. 2020 Feb;41(1):29–35. 10.1055/a-0973-8517 DOI: https://doi.org/10.1055/a-0973-8517
  19. Schwarze V, Froelich MF, Marschner C, Knösel T, Rübenthaler J, Clevert DA. Safe and pivotal approaches using contrast-enhanced ultrasound for the diagnostic workup of non-obstetric conditions during pregnancy, a single-center experience. Arch Gynecol Obstet. 2021 Jan;303(1):103–12. 10.1007/s00404-020-05735-8 DOI: https://doi.org/10.1007/s00404-020-05735-8
  20. Purysko AS, Remer EM, Veniero JC. Focal liver lesion detection and characterization with GD-EOB-DTPA. Clin Radiol. 2011 Jul;66(7):673–84. 10.1016/j.crad.2011.01.014 DOI: https://doi.org/10.1016/j.crad.2011.01.014
  21. Neri E, Bali MA, Ba-Ssalamah A, Boraschi P, Brancatelli G, Alves FC, et al. ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol. 2016 Apr;26(4):921–31. 10.1007/s00330-015-3900-3 DOI: https://doi.org/10.1007/s00330-015-3900-3
  22. Karcaaltincaba M, Akhan O. Imaging of hepatic steatosis and fatty sparing. Eur J Radiol. 2007 Jan;61(1):33–43. 10.1016/j.ejrad.2006.11.005 DOI: https://doi.org/10.1016/j.ejrad.2006.11.005
  23. Venkatesh SK, Hennedige T, Johnson GB, Hough DM, Fletcher JG. Imaging patterns and focal lesions in fatty liver: a pictorial review. Abdom Radiol (NY). 2017 May;42(5):1374–92. 10.1007/s00261-016-1002-6 DOI: https://doi.org/10.1007/s00261-016-1002-6
  24. Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB. Fatty liver: imaging patterns and pitfalls. Radiographics. 2006;26(6):1637–53. 10.1148/rg.266065004 DOI: https://doi.org/10.1148/rg.266065004
  25. Dioguardi Burgio M, Bruno O, Agnello F, Torrisi C, Vernuccio F, Cabibbo G, et al. The cheating liver: imaging of focal steatosis and fatty sparing. Expert Rev Gastroenterol Hepatol. 2016 Jun;10(6):671–8. 10.1586/17474124.2016.1169919 DOI: https://doi.org/10.1586/17474124.2016.1169919
  26. Lupsor M, Badea R. Imaging diagnosis and quantification of hepatic steatosis: is it an accepted alternative to needle biopsy?. Rom J Gastroenterol. 2005 Dec;14(4):419–25.
  27. Vachha B, Sun MR, Siewert B, Eisenberg RL. Cystic lesions of the liver. AJR Am J Roentgenol. 2011 Apr;196(4):W355-66. 10.2214/AJR.10.5292 DOI: https://doi.org/10.2214/AJR.10.5292
  28. Labib PL, Aroori S, Bowles M, Stell D, Briggs C. Differentiating Simple Hepatic Cysts from Mucinous Cystic Neoplasms: Radiological Features, Cyst Fluid Tumour Marker Analysis and Multidisciplinary Team Outcomes. Dig Surg. 2017;34(1):36–42. 10.1159/000447308 DOI: https://doi.org/10.1159/000447308
  29. Working Group WH; WHO Informal Working Group. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop. 2003 Feb;85(2):253–61. 10.1016/S0001-706X(02)00223-1 DOI: https://doi.org/10.1016/S0001-706X(02)00223-1
  30. Pakala T, Molina M, Wu GY. Hepatic Echinococcal Cysts: A Review. J Clin Transl Hepatol. 2016 Mar;4(1):39–46. 10.14218/JCTH.2015.00036 DOI: https://doi.org/10.14218/JCTH.2015.00036
  31. Stojkovic M, Rosenberger K, Kauczor HU, Junghanss T, Hosch W. Diagnosing and staging of cystic echinococcosis: how do CT and MRI perform in comparison to ultrasound?. PLoS Negl Trop Dis. 2012;6(10):e1880. 10.1371/journal.pntd.0001880 DOI: https://doi.org/10.1371/journal.pntd.0001880
  32. Brunetti E, Kern P, Vuitton DA; Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010 Apr;114(1):1–16. 10.1016/j.actatropica.2009.11.001 DOI: https://doi.org/10.1016/j.actatropica.2009.11.001
  33. Taourel P, Marty-Ane B, Charasset S, Mattei M, Devred P, Bruel JM. Hydatid cyst of the liver: comparison of CT and MRI. J Comput Assist Tomogr. 1993;17(1):80–5. 10.1097/00004728-199301000-00014 DOI: https://doi.org/10.1097/00004728-199301000-00014
  34. Kantarci M, Pirimoglu B, Ogul H, Bayraktutan U, Eren S, Aydinli B, et al. Can biliary-cyst communication be predicted by Gd-EOB-DTPA-enhanced MR cholangiography before treatment for hepatic hydatid disease?. Clin Radiol. 2014 Jan;69(1):52–8. 10.1016/j.crad.2013.08.005 DOI: https://doi.org/10.1016/j.crad.2013.08.005
  35. Kunze G, Staritz M, Köhler M. Contrast-enhanced ultrasound in different stages of pyogenic liver abscess. Ultrasound Med Biol. 2015 Apr;41(4):952–9. 10.1016/j.ultrasmedbio.2014.12.001 DOI: https://doi.org/10.1016/j.ultrasmedbio.2014.12.001
  36. Lee TY, Wan YL, Tsai CC. Gas-containing liver abscess: radiological findings and clinical significance. Abdom Imaging. 1994;19(1):47–52. 10.1007/BF02165861 DOI: https://doi.org/10.1007/BF02165861
  37. Bächler P, Baladron MJ, Menias C, Beddings I, Loch R, Zalaquett E, et al. Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential Pitfalls. Radiographics. 2016;36(4):1001–23. 10.1148/rg.2016150196 DOI: https://doi.org/10.1148/rg.2016150196
  38. Chan JH, Tsui EY, Luk SH, Fung AS, Yuen MK, Szeto ML, et al. Diffusion-weighted MR imaging of the liver: distinguishing hepatic abscess from cystic or necrotic tumor. Abdom Imaging. 2001;26(2):161–5. 10.1007/s002610000122 DOI: https://doi.org/10.1007/s002610000122
  39. Rossi B, Gasperini ML, Leflon-Guibout V, Gioanni A, de Lastours V, Rossi G, et al. Hypervirulent Klebsiella pneumoniae in Cryptogenic Liver Abscesses, Paris, France. Emerg Infect Dis. 2018 Feb;24(2):221–9. 10.3201/eid2402.170957 DOI: https://doi.org/10.3201/eid2402.170957
  40. Roediger R, Lisker-Melman M. Pyogenic and Amebic Infections of the Liver. Gastroenterol Clin North Am. 2020 Jun;49(2):361–77. 10.1016/j.gtc.2020.01.013 DOI: https://doi.org/10.1016/j.gtc.2020.01.013
  41. Leon M, Chavez L, Surani S. Hepatic hemangioma: what internists need to know. World J Gastroenterol. 2020 Jan;26(1):11–20. 10.3748/wjg.v26.i1.11 DOI: https://doi.org/10.3748/wjg.v26.i1.11
  42. Dietrich CF, Mertens JC, Braden B, Schuessler G, Ott M, Ignee A. Contrast-enhanced ultrasound of histologically proven liver hemangiomas. Hepatology. 2007 May;45(5):1139–45. 10.1002/hep.21615 DOI: https://doi.org/10.1002/hep.21615
  43. Kim KW, Kim AY, Kim TK, Kim SY, Kim MJ, Park MS, et al. Hepatic hemangiomas with arterioportal shunt: sonographic appearances with CT and MRI correlation. AJR Am J Roentgenol. 2006 Oct;187(4):W406-14. 10.2214/AJR.05.0611 DOI: https://doi.org/10.2214/AJR.05.0611
  44. Mamone G, Di Piazza A, Carollo V, Cannataci C, Cortis K, Bartolotta TV, et al. Imaging of hepatic hemangioma: from A to Z. Abdom Radiol (NY). 2020 Mar;45(3):672–91. 10.1007/s00261-019-02294-8 DOI: https://doi.org/10.1007/s00261-019-02294-8
  45. Cogley JR, Miller FH. MR imaging of benign focal liver lesions. Radiol Clin North Am. 2014 Jul;52(4):657–82. 10.1016/j.rcl.2014.02.005 DOI: https://doi.org/10.1016/j.rcl.2014.02.005
  46. Kamaya A, Maturen KE, Tye GA, Liu YI, Parti NN, Desser TS. Hypervascular liver lesions. Semin Ultrasound CT MR. 2009 Oct;30(5):387–407. 10.1053/j.sult.2009.06.001 DOI: https://doi.org/10.1053/j.sult.2009.06.001
  47. Chung YE, Kim MJ, Kim YE, Park MS, Choi JY, Kim KW. Characterization of incidental liver lesions: comparison of multidetector CT versus Gd-EOB-DTPA-enhanced MR imaging. PLoS One. 2013 Jun;8(6):e66141. 10.1371/journal.pone.0066141 DOI: https://doi.org/10.1371/journal.pone.0066141
  48. Bauditz JF, Wermke W. Sonomorphologie, Vaskularisation und Wachstumsverhalten von Fokal Nodulären Hyperplasien der Leber im Langzeitverlauf. Z Gastroenterol. 2007;45(8):45. 10.1055/s-2007-988117 DOI: https://doi.org/10.1055/s-2007-988117
  49. Dong Y, Wang WP, Mao F, Zhang Q, Yang D, Tannapfel A, et al. Imaging Features of Fibrolamellar Hepatocellular Carcinoma with Contrast-Enhanced Ultrasound . Ultraschall Med. 2020 . DOI: https://doi.org/10.1055/a-1110-7124
  50. Zarzour JG, Porter KK, Tchelepi H, Robbin ML. Contrast-enhanced ultrasound of benign liver lesions. Abdom Radiol (NY). 2018 Apr;43(4):848–60. 10.1007/s00261-017-1402-2 DOI: https://doi.org/10.1007/s00261-017-1402-2
  51. Zech CJ, Grazioli L, Breuer J, Reiser MF, Schoenberg SO. Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA-enhanced liver magnetic resonance imaging: results of a multicenter trial. Invest Radiol. 2008 Jul;43(7):504–11. 10.1097/RLI.0b013e3181705cd1 DOI: https://doi.org/10.1097/RLI.0b013e3181705cd1
  52. McInnes MD, Hibbert RM, Inácio JR, Schieda N. Focal Nodular Hyperplasia and Hepatocellular Adenoma: Accuracy of Gadoxetic Acid-enhanced MR Imaging—A Systematic Review. Radiology. 2015 Nov;277(2):413–23. 10.1148/radiol.2015142986 DOI: https://doi.org/10.1148/radiol.2015142986
  53. Sempoux C, Balabaud C, Paradis V, Bioulac-Sage P. Hepatocellular nodules in vascular liver diseases. Virchows Arch. 2018 Jul;473(1):33–44. 10.1007/s00428-018-2373-6 DOI: https://doi.org/10.1007/s00428-018-2373-6
  54. Mamone G, Carollo V, Di Piazza A, Cortis K, Degiorgio S, Miraglia R. Budd-Chiari Syndrome and hepatic regenerative nodules: magnetic resonance findings with emphasis of hepatobiliary phase. Eur J Radiol. 2019 Aug;117:15–25. 10.1016/j.ejrad.2019.05.015 DOI: https://doi.org/10.1016/j.ejrad.2019.05.015
  55. Kogiso T, Tokushige K. Fontan-associated liver disease and hepatocellular carcinoma in adults. Sci Rep. 2020 ;10(1):21742. PubMed PMID: 33303924. PMCID: PMC7728791. 10.1038/s41598-020-78840-y DOI: https://doi.org/10.1038/s41598-020-78840-y
  56. Nault JC, Couchy G, Balabaud C, Morcrette G, Caruso S, Blanc JF, et al.; GENTHEP Investigators. Molecular Classification of Hepatocellular Adenoma Associates With Risk Factors, Bleeding, and Malignant Transformation. Gastroenterology. 2017 Mar;152(4):880–894.e6. 10.1053/j.gastro.2016.11.042 DOI: https://doi.org/10.1053/j.gastro.2016.11.042
  57. Romailler É, Schmidt Kobbe S, Moradpour D, Sempoux C. [Hepatocellular adenoma: update 2020]. Rev Med Suisse. 2020 Sep 2;16(704):1554-9. PubMed PMID: 32880111. Epub 2020/09/04. Adénomes hépatocellulaires : update 2020. fre. DOI: https://doi.org/10.53738/REVMED.2020.16.704.1554
  58. Katabathina VS, Menias CO, Shanbhogue AK, Jagirdar J, Paspulati RM, Prasad SR. Genetics and imaging of hepatocellular adenomas: 2011 update. Radiographics. 2011 Oct;31(6):1529–43. 10.1148/rg.316115527 DOI: https://doi.org/10.1148/rg.316115527
  59. Purysko AS, Remer EM, Coppa CP, Obuchowski NA, Schneider E, Veniero JC. Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI. AJR Am J Roentgenol. 2012 Jan;198(1):115–23. 10.2214/AJR.11.6836 DOI: https://doi.org/10.2214/AJR.11.6836
  60. Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, et al.; World Federation for Ultrasound in Medicine; European Federation of Societies for Ultrasound. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol. 2013 Feb;39(2):187–210. 10.1016/j.ultrasmedbio.2012.09.002
  61. Seitz K, Bernatik T, Strobel D, Blank W, Friedrich-Rust M, Strunk H, et al. Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions in clinical practice (DEGUM Multicenter Trial): CEUS vs. MRI—a prospective comparison in 269 patients. Ultraschall Med. 2010 Oct;31(5):492–9. 10.1055/s-0029-1245591 DOI: https://doi.org/10.1055/s-0029-1245591
  62. Seitz K, Strobel D, Bernatik T, Blank W, Friedrich-Rust M, Herbay A, et al. Contrast-Enhanced Ultrasound (CEUS) for the characterization of focal liver lesions - prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial). Parts of this manuscript were presented at the Ultrasound Dreiländertreffen 2008, Davos. Ultraschall Med. 2009 Aug;30(4):383–9. 10.1055/s-0028-1109673 DOI: https://doi.org/10.1055/s-0028-1109673
  63. Strobel D, Bernatik T, Blank W, Schuler A, Greis C, Dietrich CF, et al. Diagnostic accuracy of CEUS in the differential diagnosis of small (≤ 20 mm) and subcentimetric (≤ 10 mm) focal liver lesions in comparison with histology. Results of the DEGUM multicenter trial. Ultraschall Med. 2011 Dec;32(6):593–7. 10.1055/s-0031-1271114 DOI: https://doi.org/10.1055/s-0031-1271114
  64. Friedrich-Rust M, Klopffleisch T, Nierhoff J, Herrmann E, Vermehren J, Schneider MD, et al. Contrast-Enhanced Ultrasound for the differentiation of benign and malignant focal liver lesions: a meta-analysis. Liver Int. 2013 May;33(5):739–55. 10.1111/liv.12115 DOI: https://doi.org/10.1111/liv.12115
  65. Zhang L, Zhang L, Wang H, Chen L, Sui G. Diagnostic performance of contrast-enhanced ultrasound and magnetic resonance imaging for detecting colorectal liver metastases: A systematic review and meta-analysis. Dig Liver Dis. 2019 Sep;51(9):1241–8. 10.1016/j.dld.2019.06.004 DOI: https://doi.org/10.1016/j.dld.2019.06.004
  66. Sawatzki M, Meyenberger C, Brand S, Semela D. Contrast-enhanced ultrasound (CEUS) has excellent diagnostic accuracy in differentiating focal liver lesions: results from a Swiss tertiary gastroenterological centre. Swiss Med Wkly. 2019 Jun;149:w20087. 10.4414/smw.2019.20087 DOI: https://doi.org/10.4414/smw.2019.20087
  67. Sawatzki M, Güller U, Güsewell S, Husarik DB, Semela D, Brand S. Contrast-enhanced ultrasound can guide the therapeutic strategy by improving the detection of colorectal liver metastases. J Hepatol. 2021 Feb;74(2):419–27. 10.1016/j.jhep.2020.09.036 DOI: https://doi.org/10.1016/j.jhep.2020.09.036
  68. Haimerl M, Wächtler M, Platzek I, Müller-Wille R, Niessen C, Hoffstetter P, et al. Added value of Gd-EOB-DTPA-enhanced Hepatobiliary phase MR imaging in evaluation of focal solid hepatic lesions. BMC Med Imaging. 2013 Dec;13(1):41. 10.1186/1471-2342-13-41 DOI: https://doi.org/10.1186/1471-2342-13-41
  69. Ko Y, Kim J, Park JK, Kim H, Cho JY, Kang SB, et al. Limited detection of small (≤ 10 mm) colorectal liver metastasis at preoperative CT in patients undergoing liver resection. PLoS One. 2017 Dec;12(12):e0189797. 10.1371/journal.pone.0189797 DOI: https://doi.org/10.1371/journal.pone.0189797
  70. Desai A, Sandhu S, Lai JP, Sandhu DS. Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review. World J Hepatol. 2019 Jan;11(1):1–18. 10.4254/wjh.v11.i1.1 DOI: https://doi.org/10.4254/wjh.v11.i1.1
  71. Cho SW, Marsh JW, Steel J, Holloway SE, Heckman JT, Ochoa ER, et al. Surgical management of hepatocellular adenoma: take it or leave it?. Ann Surg Oncol. 2008 Oct;15(10):2795–803. 10.1245/s10434-008-0090-0 DOI: https://doi.org/10.1245/s10434-008-0090-0
  72. Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V, Hollywood C, et al. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut. 2020 Aug;69(8):1382–403. 10.1136/gutjnl-2020-321299 DOI: https://doi.org/10.1136/gutjnl-2020-321299
  73. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD; American Association for the Study of Liver Diseases. Liver biopsy. Hepatology. 2009 Mar;49(3):1017–44. 10.1002/hep.22742 DOI: https://doi.org/10.1002/hep.22742

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