Background. Focal liver lesions and metastasis can be very hard to localize. For best imaging, customizing of several settings of the machine are necessary: brightness, contrast, probe frequency, focusing, dynamic range, time gain compensation, flow area, flow gain, sample volume, angle, peak repetitive frequency, filter adjusting and parallelogram of region of interest. Aim. The aim of this study is to examine the influence of adjusted or not adjusted ultrasound scanner in diagnosing of focal liver lesions. Material and methods. The study involves 129 patients from the group of focal liver lesions including a broad spectrum of benign, malignant, and infectious aetiologies. We made ultrasound examination with automatic factory settings of ultrasound machine parameters and after that all off them were examined with manual settings of the scanner. Results. The results obtained from “auto” and “manual” mode settings were compared with CT and MRI imaging as a gold standard. In auto mode false positive results were seen in patients with hiperechoic metastases understood like FNH, patients with hipoechoic metastases treated like haemangioma, patients with anechoic metastases and patients with abscesses treated like cysts. Conclusion. Manual mode ultrasound procedure is more accurate in detection of focal liver parenchymal lesions because of reduced specificity in auto mode compared with higher specificity and small percentage of false positive results within manually adjusted scanner. We show the great value of best performance manual setting of the scanner in liver parenchymal focal lesions detecting. OPEN ACCESS