Contrast-enhanced ultrasound

Contrast-enhanced ultrasound (CEUS) involves the administration of intravenous contrast agents containing microbubbles of gas. First-generation ultrasound contrast agents contained microbubbles of air that were dissolved in blood when exposed to acoustic pressure in the ultrasound field. First-generation contrast agent hence were present in bloodstream for a limited time 1. Second-generation contrast agents include microbubbles of perfluorocarbon, nitrogen gas, or sulphur hexafluoride stabilized in a phospholipid membrane. The bubbles oscillate when exposed to ultrasound beam (they are being compressed by the effect of positive pressure created by the ultrasound waves and they expand in negative pressure phase). The compression of the gas is greater than expansion which creates a non-linear response (echo). This greatly affects ultrasound backscatter and increases vascular contrast in a similar manner to intravenous contrast agents used in CT and MRI 2.  Examples of ultrasound contrast agents available commercially include SonoVue (Bracco).

CEUS has the advantage over contrast-enhanced MRI and CT in patients with contraindications such as renal failure or contrast allergy. CEUS also allows for dynamic and repeat examinations. 

An individual microbubble is estimated to measure approximately 6 micrometers, compared to a human erythrocyte measuring approximately 9 micrometers.  Microbubbles are therefore not filtered in the lungs since they are equivalent in size to red blood cells. Microbubbles are different than the agitated saline used in echocardiographic "bubble studies".

Non-targeted contrast-enhanced ultrasound

More common method

  • dynamic evaluation of the vascularity of a target lesion, most commonly in the liver or kidney, may be useful in diagnosis
  • used to measure organ perfusion, which can be useful in diagnosing diffuse processes (e.g. cirrhosis)
Targeted contrast-enhanced ultrasound

Contrast agents designed to bind to specific molecules, which are then targeted at tissues expressing that substance.

Ultrasound - general index
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Article information

rID: 27413
Section: Physics
Synonyms or Alternate Spellings:
  • CEUS
  • Contrast-enhanced ultrasound

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Cases and figures

  • Longitudinal cont...
    Case 1: neoplastic thrombus in IVC
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  • Contrast enhanced...
    Case 2: amoebic hepatic abscess
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  • This image during...
    Case 3: pyogenic liver abscess
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  • Case 4: hepatic hemangioma
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  • Case 5: focal nodular hyperplasia
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