Role of Ultrasound Contrast Agents in the Evaluation of Hepatic Masses: Diagnostic Accuracy and Clinical Utility in a Tertiary Care Setting

Background: Hepatic masses present a significant diagnostic challenge, requiring precise differentiation between benign and malignant lesions to guide appropriate clinical management. Contrast-enhanced ultrasound (CEUS) has emerged as a valuable, real-time imaging modality, particularly for patients with contraindications to iodinated contrast agents. However, its diagnostic performance relative to contrast-enhanced magnetic resonance imaging (CE-MRI) remains a subject of ongoing investigation. This study evaluates the diagnostic accuracy, lesion characterization capability, and clinical utility of CEUS in hepatic mass evaluation in a tertiary care setting. Material and Methods: This prospective observational study was conducted at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, over six months. A total of 150 adult patients with newly detected focal hepatic lesions on conventional ultrasound underwent CEUS, with CE-MRI serving as the reference standard. Lesions were classified as benign or malignant based on standardized CEUS and MRI diagnostic criteria, considering enhancement patterns, washout characteristics, and lesion morphology. Diagnostic accuracy metrics, including sensitivity, specificity, PPV, NPV, and AUC, were assessed. Additionally, the safety and feasibility of CEUS were analyzed, focusing on adverse reactions and the proportion of cases where CEUS alone provided a conclusive diagnosis. Findings Diagnostic Performance: CEUS demonstrated a sensitivity of 55%, specificity of 44%, and an overall accuracy of 50% in differentiating benign from malignant hepatic lesions, with an AUC of 0.50. Lesion Characterization: High agreement was observed between CEUS and CE-MRI for HCC, hemangiomas, and focal nodular hyperplasia (FNH), whereas moderate agreement was noted for metastatic lesions. Safety Profile: CEUS was well-tolerated, with 85% of patients experiencing no adverse effects. Mild reactions occurred in 10%, moderate reactions in 4%, and 1% had severe reactions, reaffirming its excellent safety profile. Clinical Utility: CEUS provided a definitive diagnosis in 75% of cases, reducing the need for additional imaging. It was particularly beneficial for patients with renal impairment or contrast allergies (20% of the cohort), offering a safe alternative to contrast-enhanced MRI. CEUS is a safe, feasible, and effective imaging modality for hepatic lesion characterization, demonstrating strong diagnostic agreement with CE-MRI, particularly for HCC and benign hepatic lesions. Its real-time imaging capability, non-ionizing nature, and suitability for patients with contrast contraindications reinforce its role as a first-line diagnostic tool in hepatic imaging. Future studies should explore multimodal imaging strategies, AI-driven enhancement techniques, and standardized protocols to optimize the diagnostic performance of CEUS.