Liver Ultrasonography: From Basic Principles to Current Approaches
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Review
VOLUME: 14 ISSUE: 1
P: 9 - 19
April 2026

Liver Ultrasonography: From Basic Principles to Current Approaches

Turk Radiol Semin 2026;14(1):9-19
1. Ankara Üniversitesi Tıp Fakültesi, İbni Sina Araştırma ve Uygulama Hastanesi, Radyoloji Anabilim Dalı, Ankara, Türkiye
2. Beytepe Şehit Murat Erdi Eker Devlet Hastanesi, Radyoloji Kliniği, Ankara, Türkiye
No information available.
No information available
Received Date: 18.02.2026
Accepted Date: 12.03.2026
Online Date: 27.04.2026
Publish Date: 27.04.2026
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ABSTRACT

Liver ultrasonography (US) continues to be one of the primary imaging modalities for the evaluation of hepatic diseases in clinical practice due to its ease of use, non-invasive nature, and wide availability. Its ability to provide real-time imaging, absence of ionizing radiation, and repeatability make US indispensable in both diagnostic and follow-up processes. In addition to conventional B-mode US, Doppler techniques, contrast-enhanced ultrasound, and elastography enable a more detailed assessment of the structural and functional characteristics of liver diseases. These advancements have increased the clinical contribution of US, particularly in the characterization of focal liver lesions and the evaluation of diffuse parenchymal liver diseases. Its bedside applicability and ability to ensure patient comfort further establish US as a powerful tool in multidisciplinary clinical decision-making. Contemporary ultrasound approaches assume a complementary role alongside computed tomography and magnetic resonance imaging, offering rapid, reliable, and cost-effective solutions in patient management. This review aims to provide an overall perspective on the clinical importance of liver US and the contribution of current imaging techniques to diagnostic processes.

Keywords:
Elastography, liver, ultrasonography

References

1
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; 46: 2579-604.
2
Wilson SR, Burns PN. Microbubble-enhanced US in body imaging: what role? Radiology. 2010; 257: 24-39.
3
Becker CD, Cooperberg PL. Sonography of the hepatic vascular system. AJR Am J Roentgenol. 1988; 150: 999-1005.
4
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; 32: 1369-75.
5
Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: part 3: liver. Ultrasound Med Biol. 2015; 41: 1161-79.
6
Ferraioli G, Soares Monteiro LB. Ultrasound-based techniques for the diagnosis of liver steatosis. World J Gastroenterol. 2019; 25: 6053-62.
7
Çullu N, Deveer M, Karaca L, Doğan F. Benign fokal karaciğer lezyonlarının radyolojik bulguları. Turkiye Klinikleri J Gastroenterohepatol-Special Topics. Ankara: 2014.p.77-82.
8
Nicolau C, Bianchi L, Vilana R. Gray-scale ultrasound in hepatic cirrhosis and chronic hepatitis: diagnosis, screening, and intervention. Semin Ultrasound CT MR. 2002; 23: 3-18.
9
Goyal N, Jain N, Rachapalli V, Cochlin DL, Robinson M. Non-invasive evaluation of liver cirrhosis using ultrasound. Clin Radiol. 2009; 64: 1056-66.
10
Iliopoulos P, Vlychou M, Karatza C, Yarmenitis SD, Repanti M, Tsamis I, et al. Ultrasonography in differentiation between chronic viral hepatitis and compensated early stage cirrhosis. World J Gastroenterol. 2008; 14: 2072-9.
11
Park HS, Desser TS, Jeffrey RB, Kamaya A. Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score. J Ultrasound Med. 2017; 36: 725-30.
12
Tchelepi H, Ralls PW, Radin R, Grant E. Sonography of diffuse liver disease. J Ultrasound Med. 2002; 21: 1023-32; quiz 1033-4.
13
Ros PR. Imaging of diffuse and inflammatory liver disease. 2018 Mar 21. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book [Internet]. Cham (CH): Springer; 2018. Chapter 22.
14
Shyamanur B, Khalili K, Elbanna KY. The impact of diffuse liver disease on liver lesion detection and characterization. Can Assoc Radiol J. 2026; 77: 380-8.
15
Pietrangelo A. Hereditary hemochromatosis: pathogenesis, diagnosis, and treatment. Gastroenterology. 2010; 139: 393-408, 408.e1-2.
16
European Association for Study of Liver. EASL clinical practice guidelines: Wilson’s disease. J Hepatol. 2012; 56: 671-85.
17
Park MA, Mueller PS, Kyle RA, Larson DR, Plevak MF, Gertz MA. Primary (AL) hepatic amyloidosis: clinical features and natural history in 98 patients. Medicine (Baltimore). 2003; 82: 291-8.
18
Marrero JA, Ahn J, Rajender Reddy K; Americal College of Gastroenterology. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014; 109: 1328-47; quiz 1348.
19
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; 45: 672-91.
20
Mounajjed T. Hepatocellular adenoma and focal nodular hyperplasia. Clin Liver Dis (Hoboken). 2021; 17: 244-8.
21
Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A. Hepatic adenomas: imaging and pathologic findings. Radiographics. 2001; 21: 877-92; discussion 892-4.
22
Mortelé KJ, Ros PR. Cystic focal liver lesions in the adult: differential CT and MR imaging features. Radiographics. 2001; 21: 895-910.
23
Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018; 391: 1301-14.
24
Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 Practice Guidance by the American Association for the study of liver diseases. Hepatology. 2018; 68: 723-50.
25
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; 34: 11-29.
26
Fraquelli M, Nadarevic T, Colli A, Manzotti C, Giljaca V, Miletic D, et al. Contrast-enhanced ultrasound for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database Syst Rev. 2022; 9: CD013483.
27
Porrello G, Mamone G, Miraglia R. Budd-Chiari syndrome imaging diagnosis: state of the art and future perspectives. Diagnostics (Basel). 2023; 13: 2256.
28
DeLeve LD, Valla DC, Garcia-Tsao G; American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology. 2009; 49: 1729-64.
29
Cura M, Haskal Z, Lopera J. Diagnostic and interventional radiology for Budd-Chiari syndrome. Radiographics. 2009; 29: 669-81.
30
Bansal V, Gupta P, Sinha S, Dhaka N, Kalra N, Vijayvergiya R, et al. Budd-Chiari syndrome: imaging review. Br J Radiol. 2018; 91: 20180441.
31
Condat B, Pessione F, Hillaire S, Denninger MH, Guillin MC, Poliquin M, et al. Current outcome of portal vein thrombosis in adults: risk and benefit of anticoagulant therapy. Gastroenterology. 2001; 120: 490-7.
32
Chan SS, Colecchia A, Duarte RF, Bonifazi F, Ravaioli F, Bourhis JH. Imaging in hepatic veno-occlusive disease/sinusoidal obstruction syndrome. Biol Blood Marrow Transplant. 2020; 26: 1770-9.
33
Simpson S, Breshears E, Basavalingu D, Khatri G, Chan S, Fite J, et al. Review of imaging findings in hepatic veno-occlusive disease. Eur J Radiol. 2024; 177: 111526.
34
Ravaioli F, Colecchia A, Alemanni LV, Vestito A, Dajti E, Marasco G, et al. Role of imaging techniques in liver veno-occlusive disease diagnosis: recent advances and literature review. Expert Rev Gastroenterol Hepatol. 2019; 13: 463-84.
35
Sun K, Zhu W, Luo Y, Li Y, Zhou X. Transient segmental enhancement of pyogenic liver abscess: a comparison between contrast-enhanced ultrasound and computed tomography. J Comput Assist Tomogr. 2018; 42: 133-8.
36
Mortelé KJ, Segatto E, Ros PR. The infected liver: radiologic-pathologic correlation. Radiographics. 2004; 24: 937-55.
37
Popescu A, Sporea I, Şirli R, Dănilă M, Mare R, Grădinaru Taşcău O, et al. Does contrast enhanced ultrasound improve the management of liver abscesses? A single centre experience. Med Ultrason. 2015; 17: 451-5.
38
Sulima M, Nahorski W, Gorycki T, Wołyniec W, Wąż P, Felczak-Korzybska I, et al. Ultrasound images in hepatic alveolar echinococcosis and clinical stage of the disease. Adv Med Sci. 2019; 64: 324-30.
39
Kunze G, Staritz M, Köhler M. Contrast-enhanced ultrasound in different stages of pyogenic liver abscess. Ultrasound Med Biol. 2015; 41: 952-9.
40
Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiology. 1981; 139: 459-63.
41
Priyadarshi RN, Kumar R, Anand U. Amebic liver abscess: clinico-radiological findings and interventional management. World J Radiol. 2022; 14: 272-85.
42
Cerban R, Iacob S, Ester C, Ghioca M, Chitul M, Iacob R, et al. Liver elastography methods for diagnosis of de novo and recurrent hepatocellular carcinoma. Diagnostics (Basel). 2025; 15: 1087.
43
Honda Y, Yoneda M, Imajo K, Nakajima A. Elastography techniques for the assessment of liver fibrosis in non-alcoholic fatty liver Disease. Int J Mol Sci. 2020; 21: 4039.
44
Ajmal S. Contrast-enhanced ultrasonography: review and applications. Cureus. 2021; 13: e18243.
45
Erlichman DB, Weiss A, Koenigsberg M, Stein MW. Contrast enhanced ultrasound: a review of radiology applications. Clin Imaging. 2020; 60: 209-15.