Liver pathology represents, nowadays, a major cause of mortality and morbidity worldwide. Since MRI helps in limited cases in the differential diagnosis of various pathologies concerning liver tumors, other modern diagnostic strategies should be prioritized. Besides various tumoral biomarkers, contrast-enhanced ultrasound (CEUS) plays a substantial role in differentiating various liver pathologies due to its availability and specificity. Various contrast-enhanced substances used for CEUS assist mainly in detecting focal liver lesions and differentiating their malignant character. This review focuses on the main indications and limits of this novel investigation, considering that patients presenting with various liver pathologies are more challenging. We highlighted in our review the similarities with the CT/MRI imaging methods in reference to the specificity and sensitivity of the method, in its potential ability to detect various liver tumors. Moreover, the contrast agents used by CEUS are eliminated throughout the lungs, showing no evidence of hepatotoxic, nephrotoxic, or cardiotoxic events. In conclusion, the accessibility and safety of the procedure and the absence of the use of ionizing radiation point out that CEUS could be a stand-alone technique in the diagnosis and evaluation of complex liver pathologies.
