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Despite the improvement in detection and characterization of focal liver lesions that can be achieved by using contrast-enhanced US, several issues remain to be resolved. First, contrast US will hardly replace CT or MR imaging for preoperative assessment of patients with liver tumors, as these techniques still offer a more comprehensive assessment of the liver parenchyma, which is mandatory to properly plan any kind of surgical or interventional procedure. Second, the daily schedule of each US laboratory doing liver examinations will have to be reformulated, and many such laboratories will have to update their equipment and provide proper training for their doctors. Last but not least, the cost of the introduction of contrast-enhanced US into daily practice will have to be taken into account. It can be argued that cost savings associated with patients who will no longer need CT or MR imaging of the liver after contrast-enhanced US could largely counterbalance the cost of the examination. However, an optimal use of contrast-enhanced US will require precise diagnostic flow charts for each clinical situation. Nevertheless, contrast-enhanced US has the potential to become the primary liver-imaging modality for early detection and characterization of focal lesions. Early diagnosis of primary and secondary liver malignancies greatly enhances the possibility of curative surgical resection or successful percutaneous ablation, resulting in better patient care and eventually in improved patient survival. [ABSTRACT FROM AUTHOR]