CEUS Differentiates FNH From HCA With 84.9% Sensitivity and 0.90 AUCUltrasound helps doctors tell two liver growths apart

Clinical radiology Published November 2, 2026 Study authors: Shen L, Altmayer S, Tse J R PubMed ↗ DOI ↗ Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

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Key Takeaway

Interpret CEUS results cautiously; findings are exploratory and reference standard was often MRI, not histology.

This meta-analysis evaluated the diagnostic performance of contrast-enhanced ultrasound (CEUS) for differentiating focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). The analysis included 228 FNHs and 155 HCAs. The comparator and setting were not reported.

CEUS demonstrated a sensitivity of 84.9% (95% CI, 69.8-93.2%) and a specificity of 84.1% (95% CI, 74.8-90.4%) for distinguishing FNH from HCA. The area under the curve was 0.90 (95% CI, 0.80-0.93%).

The authors acknowledge several limitations: a small number of studies and predominant use of MRI with hepatobiliary contrast rather than histology as the reference standard. They state that the findings should be considered exploratory. Safety data were not reported.

In practice, CEUS showed promising diagnostic performance for distinguishing FNH from HCA, but the exploratory nature of the evidence and the limitations in the reference standard warrant cautious interpretation. The results do not support routine replacement of histology or other imaging with CEUS based on this analysis alone.

How this fits prior evidence

This meta-analysis extends prior coverage of definitive diagnosis for indeterminate hepatic lesions. A prior report highlighted laparoscopic partial hepatectomy as providing definitive diagnosis and treatment for large atypical hepatic lesions in adolescents. The current analysis addresses a noninvasive alternative, CEUS, for differentiating FNH from HCA, with a sensitivity of 84.9% and specificity of 84.1%. However, the reliance on MRI with hepatobiliary contrast rather than histology as the reference standard contrasts with the definitive surgical diagnosis in the prior report. The exploratory nature of these findings means CEUS should not yet be considered a replacement for histology or surgery in indeterminate cases.

When a patient has a growth on their liver, doctors must figure out exactly what it is to decide on the best treatment. Two common types of growths, called focal nodular hyperplasia and hepatocellular adenomas, can look very similar on standard scans. This makes it hard for doctors to know if a growth is harmless or requires more action.

A review of data from 228 cases of focal nodular hyperplasia and 155 cases of hepatocellular adenomas shows that contrast-enhanced ultrasound (CEUS) is a promising tool. This specific type of ultrasound uses a special contrast agent to help doctors see the blood flow and tissue characteristics more clearly. The study found that this method had a sensitivity of 84.9% and a specificity of 84.1% in telling the two growths apart.

While these results are promising, the findings are still considered exploratory. The review was based on a small number of studies, and many of those studies used MRI scans rather than actual tissue samples as the gold standard for comparison. Because of these factors, doctors should still view this as an early look at how ultrasound can help in their daily practice.

What this means for you:

Contrast-enhanced ultrasound shows promise in helping doctors distinguish between two similar liver growths.

Common questions

What is the difference between FNH and HCA?

Both are types of growths that can appear on the liver. They often look very similar on standard imaging, which makes it difficult for doctors to tell them apart. Distinguishing between the two is important because it helps doctors determine the correct management plan for the patient.

How accurate is the ultrasound for these liver growths?

The study found that contrast-enhanced ultrasound (CEUS) had a sensitivity of 84.9% and a specificity of 84.1% in distinguishing between the two types of growths. These numbers suggest the method is a promising way to help doctors identify the specific type of liver growth a patient has.

Is this ultrasound method reliable enough to use every time?

The results are currently considered exploratory. The study was based on a small number of reports, and many used MRI scans instead of tissue samples as the comparison standard. You should talk to your doctor about how these findings might apply to your specific situation.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedNov 2026

PMID42810134

View Original Abstract ↓

AIM: Single-centre studies with modest sized samples have shown that contrast-enhanced ultrasound (CEUS) can distinguish focal nodular hyperplasia (FNH) from hepatocellular adenomas (HCAs). We performed a systematic review and meta-analysis to evaluate the diagnostic performance of CEUS in distinguishing FNH from HCA. MATERIALS AND METHODS: PubMed, Embase, and Web of Science were searched up to January 2026 for studies that evaluated FNHs and HCAs using CEUS, with histopathology or magnetic resonance imaging (MRI) with hepatobiliary contrast agent as the reference standard. The diagnostic performance of CEUS from individual studies was extracted. Pooled sensitivity and specificity with 95% confidence interval (CI) were obtained using a bivariate random-effects model. A summary receiver-operating characteristic curve (SROC) was generated to estimate the area under the curve (AUC) via parametric bootstrapping. RESULTS: Five scientific studies were included, with a total of 228 FNHs and 155 HCAs. Final diagnoses were established by histology alone in one study and by MRI with hepatobiliary contrast in four studies. Three of the five studies were at overall low risk of bias, with concerns mainly related to patient selection. The pooled sensitivity and specificity of CEUS to differentiate FNH from HCA were 84.9% (95% CI, 69.8-93.2%) and 84.1% (95% CI, 74.8-90.4%), respectively. The AUC was 0.90 (95% CI, 0.80-0.93). CONCLUSION: CEUS showed promising diagnostic performance for distinguishing FNH from HCA. However, given the small number of studies and the predominant use of MRI with hepatobiliary contrast rather than histology as the reference standard, these findings should be considered exploratory.

CEUS Differentiates FNH From HCA With 84.9% Sensitivity and 0.90 AUCUltrasound helps doctors tell two liver growths apart

How this fits prior evidence

Common questions

Study Details

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CEUS Differentiates FNH From HCA With 84.9% Sensitivity and 0.90 AUCUltrasound helps doctors tell two liver growths apart

How this fits prior evidence

Common questions

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