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Fig. 16. The performance of CEUS in our study for the main malignant and benign lesions (HCC=hepatocellular carcinoma, META=liver metastasis, HEMANG=liver hemangioma, FNH=focal nodular hyperplasia, Se=sensitivity, Sp=specificity, PPV=positive predictive

d. *Assessing therapeutic efficacy*. Using the vascular criteria allows the assessment of therapeutic efficacy under chemotherapy (Bolondi et al, 2007). Performing an interventional procedure (with diagnostic or therapeutic purpose) simultaneously with the administration of i.v. CAs increases the procedure's efficiency by a better visualization of the tumor and by correct guidance of the ablation needle in the active (vascularized) area of the tumor (Skjoldbye et al, 2002, Lencioni et al, 2004). After ablative procedures, or even better in one month after the procedure, the absence of the circulation bed in the tumor in arterial phase suggests an effective treatment (Solbiati et al, 2004; Vilana et al, 2006, Bartolotta et al, 2008). This principle is also true for chemotherapy with antiangiogenic agents. Even under these conditions combination of CEUS with i.v. contrast CT examination is required to detect small metastases between

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