Background/Objectives: This systematic review describes a largely descriptive synthesis of studies investigating the diagnostic performance of quantitative contrast-enhanced ultrasound (CEUS) in differentiating benign from malignant peripheral pulmonary lesions. Methods: Formal quantitative pooling of effect sizes was not feasible due to variability in outcome measurements and reporting. Results: Combining CEUS parameters with real-time on-site evaluation (ROSE) substantially improved percutaneous biopsy success rates. In one comparative study, biopsy yield reached 97.62% with CEUS, versus 84% using conventional ultrasound, while complications remained minimal. Other investigations focused on the discriminatory value of specific time-based indices (e.g., AT ≥ 10 s, lesion-lung AT difference ≥ 2.5 s) or complex multi-parameter models. A notable large study demonstrated that a six-parameter logistic regression model achieved near-excellent discrimination, with C-statistics exceeding 0.97 for both development and validation cohorts, outperforming single-threshold approaches. Nevertheless, certain findings emphasize that no single indicator—particularly arrival time alone—reliably distinguishes benign from malignant lesions, given the diverse vascular patterns and histological subtypes involved. TDOA-based analyses proved more promising, as malignant lesions generally exhibit a delayed but robust bronchial arterial supply and rapid washout. Heterogeneity in ultrasound systems, operator experience, and patient populations further underscores the need for standardized protocols. Conclusions: Overall, these data suggest that CEUS, particularly when combined with additional sonographic or cytological tools, significantly enhances diagnostic precision for peripheral pulmonary lesions.

Ultrasound plays a central role in the diagnosis, monitoring, and management of liver diseases. Assessing hepatic fibrosis is essential in chronic liver disease, and several diagnostic modalities are available. The gold standard remains percutaneous liver biopsy, an invasive method using a 16–18-gauge needle. A breakthrough came in 2003 with transient elastography (TE), a non-invasive technique that measures liver stiffness (kPa) via elastic wave propagation. Later, shear wave elastography (SWE), integrated into modern ultrasound systems, was developed to assess tissue elasticity. SWE generates shear waves (SWs) through acoustic radiation force, assuming tissues to be linearly elastic and homogeneous, and provides quantitative stiffness data. Recent evidence shows hepatic tissue is viscoelastic, with wave propagation varying by frequency. Quantifying viscosity remains a challenge. Fibrosis affects viscoelastic properties and shear wave speed (SWS), while necroinflammation predominantly alters the viscous component, influencing the shear wave dispersion slope (SWDS). This review provides an overview of ultrasound elastography methods, including stiffness and viscosity assessment, their physical principles, and clinical applications in hepatology.

Angiomyolipoma is a solid mesenchymal tumour that usually affects the kidney. Hepatic localization of angiomyolipoma (HAML) is rare and usually asymptomatic however it presents a challenging differential diagnosis. We present the case of a 45-year-old man affected by tuberous sclerosis complex type 2 (TSC2) and an hepatic lesion suspected to be hepatocellular carcinoma on magnetic resonance but whose Bmode ultrasound and contrast-enhanced ultrasound (CEUS) findings were consistent with benignity, as confirmed by histology.

Background: Accurate post-treatment imaging assessment of hepatocellular carcinoma (HCC) is essential for guiding retreatment, transplantation eligibility, and prognosis. The Liver Imaging Reporting and Data System Treatment Response Algorithm (LI-RADS TRA) was updated in 2024, introducing refinements across contrast-enhanced ultrasound (CEUS), CT/MRI, and radiation-based therapies, including the TR-Nonprogressing category. We aimed to systematically review current evidence on the diagnostic performance, reproducibility, and clinical implications of LI-RADS TRA v2024 for post-treatment assessment of HCC across imaging modalities and locoregional therapies. Methods: A systematic search of PubMed, Embase, Scopus, Web of Science, and CENTRAL was conducted according to PRISMA 2020 guidelines. Original studies applying LI-RADS TRA v2024 (or comparisons with earlier versions or mRECIST) after locoregional therapies were included. Outcomes of interest comprised diagnostic accuracy metrics, inter-reader and inter-modality agreement, temporal behavior of TRA categories, and prognostic associations. Given substantial heterogeneity, results were synthesized narratively. Results: Six studies met inclusion criteria. After thermal ablation, CEUS applying the non-radiation TRA v2024 showed very high specificity (approximately 88–100%) and excellent negative predictive value (about 94–98%), with substantial-to-almost-perfect inter-reader agreement (κ up to 0.92) and excellent inter-modality agreement with CT/MRI (ICC ≈ 0.90). After transarterial chemoembolization, CEUS performance was time-dependent, with higher sensitivity at early follow-up (~15 days) and higher specificity at later assessment (~30 days). On MRI, non-radiation TRA v2024 combined with ancillary features improved sensitivity and, in some analyses, accuracy compared with v2017 and v2024 without ancillary features, while remaining more specific than mRECIST. In radiation-based therapies, the radiation TRA v2024 captured delayed-response patterns through the TR-Nonprogressing category, which demonstrated meaningful temporal evolution and prognostic separation from TR-Viable. Surgical validation confirmed preserved diagnostic performance against histology. Conclusions: Despite heterogeneous data, available evidence supports LI-RADS TRA v2024 as a clinically useful framework that improves clarity, reproducibility, and actionability of post-treatment HCC imaging. CEUS is particularly effective after ablation; timing is critical after TACE, ancillary features should be routinely applied on MRI, and TR-Nonprogressing appropriately reflects radiation biology while preserving prognostic value.