- Design
- Systematic review and diagnostic accuracy meta-analysis
- Population
- 5 studies; 228 FNH and 155 hepatocellular adenomas
- Primary outcome
- Accuracy of CEUS for FNH versus adenoma
- Effect
- Sensitivity 84.9% (69.8–93.2%); specificity 84.1% (74.8–90.4%); AUC 0.90
A meta-analysis published in August 2026 pooled five studies (228 focal nodular hyperplasias, 155 hepatocellular adenomas) assessing contrast-enhanced ultrasound.
Pooled sensitivity was 84.9% (95% CI 69.8% to 93.2%) and specificity 84.1% (74.8% to 90.4%), with an area under the curve of 0.90. Four of the five studies used hepatobiliary-contrast MRI rather than histology as the reference standard.
That performance is useful but leaves roughly one in seven lesions misclassified, and the small evidence base makes it exploratory. Hepatobiliary-phase MRI remains the reference test.
CEUS may help where MRI is unavailable or contraindicated, or to triage incidental lesions found on ultrasound, provided an uncertain result goes on to MRI.
- Consider CEUS for characterising a suspected FNH or adenoma when MRI is unavailable.
- Refer uncertain CEUS results to hepatobiliary-phase MRI.
- Remember adenoma subtype and size drive management, which CEUS cannot fully assess.
- Do not rely on CEUS alone in men or in large lesions where adenoma carries higher risk.
Why it matters
It offers a cheaper, faster first look at a common benign-lesion question, but not a replacement for MRI.
Don't overread it
Five studies, mostly with MRI rather than histology as reference; the authors call it exploratory.
The statistics, in plain English
Sensitivity and specificity of about 85% mean about 15 in 100 lesions of each type would be misclassified. The wide sensitivity interval (70% to 93%) reflects the small number of studies.
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