<p>Focal liver lesions (FLLs) are common and are often first identified on abdominal ultrasound examinations. Although CT and MRI were historically required to noninvasively characterize many FLLs, introduction of microbubble contrast agents produced a groundbreaking change as contrast enhanced ultrasound (CEUS) showed vascularity to the capillary level for the first time. CEUS shows specific arterial phase enhancement patterns in benign lesions and accurately differentiates malignant lesions based on the timing and intensity of washout. Parametric time of arrival and microvascular imaging techniques can demonstrate vascularity in FLLs with significantly improved sensitivity compared with conventional Doppler techniques. Shear-wave elastography and quantitative ultrasound are generally used to evaluate diffuse liver disease but show promise in evaluation of FLLs.</p> Graphical abstract <p></p>