It is virtually impossible to imagine the practice of modern medicine as we know it in high-income countries without the use of imaging, and yet, an estimated two thirds of the global population may receive no such care.Ultrasound imaging with CEUS has the potential to correct this inequity.
A potential advantage of using Sono Vue CEUS would be the option of completing the assessment at the same time as the initial unenhanced ultrasonography.” These conclusions are broadly supported [20-22] and elegantly framed by Friedrich-Rust et al.
 in the following statement: “Use CEUS as first method of choice for the diagnostic work up of focal liver lesions if B-mode and Doppler-ultrasonography are not conclusive.” In addition, CEUS has an excellent safety profile  and patient compliance, as well as no issues regarding organ function or radiation exposure.
The most extensive material from the German Ultrasound Society drew on 1,349 patients and reported a positive predictive value of 95.4% and a negative predictive value of 95.7% in differentiating between malignant and benign lesions .
In two 2011 meta-analyses of CEUS versus contrast-enhanced CT and MRI, the overall performance of the three modalities was statistically equal, with reported sensitivity and specificity ratios ranging from 81% to 89%.
Therefore, when available, CEUS should be the first method to answer the above question of “Are the lesions benign or malignant?