From the March 2018 issue of HealthCare Business News magazine

Initially championed in European countries, CEUS has been widely utilized in adult echocardiography and additional uses are gaining traction in the U.S. In addition, recent expansion of the Food and Drug Administration’s approval for a specific US contrast agent in the pediatric population has encouraged further exploration into the applications of this imaging technique. Intravesicular administration, where the contrast agent is directly introduced into the patient’s bladder via catheter, has been used in US voiding cystourethrogram examinations to allow visualization of urologic anatomy and detection of vesicoureteral reflux in children. The use of CEUS obviates the need for radiation exposure, which is required with the traditional imaging examination in this situation (fluoroscopic vesicoureterography). CEUS has also been used following intravenous administration for a wide variety of indications including characterization of indeterminate liver lesions, evaluation of solid organ injury following blunt abdominal trauma and hypoxic-ischemic brain injury.

Despite the multitude of medical indications for which CEUS has been explored, these should be considered the “tip of the iceberg” for future imaging applications. CEUS plays an important role at our institution in troubleshooting challenging cases, particularly where there is a strong desire to avoid sedation or radiation exposure to the child. One common example is with oncology (cancer) patients in whom staging and recurrent follow-up examinations require CT or MRI and any abnormalities identified on these imaging studies necessitate accurate characterization to exclude recurrence or metastasis. At our institution, we frequently employ CEUS to better delineate complex cystic lesions of the kidney and indeterminate lesions of the liver to determine the need for biopsy or resection. This imaging technology has also been used by interventional radiologists to identify solid components of tumors as targets for image-guided biopsy, ensure adequate placement of drainage catheters and continuity of abscess cavities, depict vascular anatomy and confirm correct placement of tubes and lines of the gastrointestinal tract or vascular system. Where traditional imaging modalities may be inadequate in determining the diagnosis or be limited in their ability to sufficiently depict abnormalities, CEUS can be considered.


In addition to the diagnostic benefits of CEUS, novel scientific advancements in image processing methods now allow production of quantifiable metrics which can complement and enhance diagnostic information while also providing functional data. These metrics, such as time-to-peak, wash-in-slope, peak intensity and wash-out-slope, have the benefit of assessing more than just “where” there is blood flow, but also “how much” and “how quickly.” These quantification methods, while still in their infancy, have the ability to transform US into an important modality for functional imaging.

March 2018 Magazine

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