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World J Radiol. Dec 31, 2009; 1(1): 15-24
Published online Dec 31, 2009. doi: 10.4329/wjr.v1.i1.15
Contrast-enhanced ultrasound: The evolving applications
Hui-Xiong Xu
Hui-Xiong Xu, Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, The Center of Guangdong Province for the Study of Diagnostic Ultrasound and Interventional Therapy, 58 Zhongshan Road 2, Guangzhou 510080, Guangdong Province, China
Author contributions: Xu HX solely contributed to this paper.
Supported by In part by grant No. NCET-06-0723 from the Chinese Ministry of Education and grant 2008-2-10 of Public Welfare Research Special Project from the Chinese Ministry of Health
Correspondence to: Hui-Xiong Xu, MD, PhD, Professor, Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, The Center of Guangdong Province for the Study of Diagnostic Ultrasound and Interventional Therapy, 58 Zhongshan Road 2, Guangzhou 510080, Guangdong Province, China. xuhuixiong@hotmail.com
Telephone: +86-20-87765183 Fax: +86-20-87765183
Received: November 5, 2009
Revised: December 17, 2009
Accepted: December 21, 2009
Published online: December 31, 2009
Abstract

Contrast-enhanced ultrasound (CEUS) is a major breakthrough for ultrasound imaging in recent years. By using a microbubble contrast agent and contrast-specific imaging software, CEUS is able to depict the micro- and macro-circulation of the targeted organ, which in turn leads to improved performance in diagnosis. Due to the special dual blood supply system in the liver, CEUS is particularly suitable for liver imaging. It is evident that CEUS facilitates improvement for characterization of focal liver lesions (FLLs), detection of liver malignancy, guidance for interventional procedures, and evaluation of treatment response after local therapies. CEUS has been demonstrated to be equal to contrast-enhanced computed tomography or magnetic resonance imaging for the characterization of FLLs. In addition, the applicability of CEUS has expanded to non-liver structures such as gallbladder, bile duct, pancreas, kidney, spleen, breast, thyroid, and prostate. The usefulness of CEUS in these applications is confirmed by extensive literature production. Novel applications include detecting bleeding sites and hematomas in patients with abdominal trauma, guiding percutaneous injection therapy and therefore achieving the goal of using interventional ultrasonography in managing splenic trauma, assessing the activity of Crohn’s disease, and detecting suspected endoleaks after endovascular abdominal aneurysm repair. Contrast-enhanced intraoperative ultrasound (US) and intracavitary use of CEUS have been developed and clinically studied. The potential use of CEUS involves sentinel lymph node detection, drug or gene delivery, and molecular imaging. In conclusion, the advent of CEUS has greatly enhanced the usefulness of US and even changed the status of US in clinical practice. The application of CEUS in the clinic is continuously evolving and it is expected that its use will be expanded further in the future.

Keywords: Bile duct; Breast; Gallbladder; Pancreas; Kidney; Liver; Contrast-enhanced ultrasound; Prostate; Spleen; Thyroid