The development of contrast agents for ultrasound has significantly extended its clinical applications, particularly in the detection and characterization of focal liver lesions. Real-time evaluation of the vascular phase currently can be achieved by combining new microbubble-specific methods with second-generation contrast agents. The enhancement pattern in the vascular phase combined with the behavior in the liver-specific late phase allows characterization of the most frequent focal liver lesions, with an accuracy similar to those of dynamic computed tomography and magnetic resonance imaging.