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Fig. 3. —Hepatocellular carcinoma in 57-year-old man with liver cirrhosis and steatosis. Oblique sagittal native B-mode sonogram (upper left) shows lobulated, hypoechoic mass (arrow) with posterior acoustic enhancement (arrowheads) in cirrhotic liver. Note finely increased echogenicity of background liver, suggesting combined hepatic steatosis. On power Doppler sonogram (upper middle), no intratumoral vascularity is noted. This was considered to be indeterminate lesion by one radiologist and a definitely malignant lesion by another radiologist and was classified as a malignant lesion by both radiologists. However, one radiologist answered that this lesion was not specifically characterized and requested further imaging. Other radiologist correctly characterized this lesion as hepatocellular carcinoma. Serial contrast-enhanced agent detection images obtained 29 sec (upper right), 35 sec (lower left), 83 sec (lower middle), and 3 min (lower right) after contrast injection show early heterogenous enhancement (arrows) of lesion on arterial phases (upper right and lower left) and washout (arrowheads) during portal (lower middle) and delayed (lower right) phases. On basis of features of contrast-enhanced sonography, this lesion was correctly characterized as hepatocellular carcinoma and no further imaging workup was requested by either radiologist.