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Contrast-Enhanced Ultrasound: What Is the Evidence and What Are the Obstacles?

Stephanie R. Wilson1, Lennard D. Greenbaum2 and Barry B. Goldberg3

1 Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 St., NW, Calgary, AB T2N 2T9, Canada.
2 The Hughes Center for Fetal Diagnostics, Winnie Palmer Hospital for Women & Babies, Orlando, FL.
3 Division of Ultrasound, Thomas Jefferson University Hospital, Philadelphia, PA.


Figure 1
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  		Fig. 1A —Hepatocellular carcinoma in 67-year-old woman with alcoholic cirrhosis. Analogous enhancement information is shown on contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT. Baseline transverse ultrasound image shows mixed echogenic mass in cirrhotic liver.

 

Figure 2
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  		Fig. 1B —Hepatocellular carcinoma in 67-year-old woman with alcoholic cirrhosis. Analogous enhancement information is shown on contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT. Arterial phase CEUS image shows hypervascular mass.

 

Figure 3
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  		Fig. 1C —Hepatocellular carcinoma in 67-year-old woman with alcoholic cirrhosis. Analogous enhancement information is shown on contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT. Portal venous phase CEUS image obtained at 150 seconds shows washout of lesion such that it is now less enhanced than adjacent liver.

 

Figure 4
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  		Fig. 1D —Hepatocellular carcinoma in 67-year-old woman with alcoholic cirrhosis. Analogous enhancement information is shown on contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT. Unenhanced CT image shows lesion is hypoattenuating.

 

Figure 5
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  		Fig. 1E —Hepatocellular carcinoma in 67-year-old woman with alcoholic cirrhosis. Analogous enhancement information is shown on contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT. Contrast-enhanced arterial phase CT image shows lesion is hypervascular.

 

Figure 6
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  		Fig. 1F —Hepatocellular carcinoma in 67-year-old woman with alcoholic cirrhosis. Analogous enhancement information is shown on contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT. Portal venous phase image shows lesion has washed out. Both CT and CEUS suggest hepatocellular carcinoma.

 

Figure 7
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  		Fig. 2A —Focal nodular hyperplasia in asymptomatic 22-year-old woman. Arterial phase contrast-enhanced ultrasound (CEUS) images obtained with maximum-intensity-projection technique show superb vessel delineation. For video, see Figure S2 in supplemental data at www.ajronline.org. (Reprinted with permission from [35]) Baseline sagittal image shows bulbous expansion of tip of left lobe of liver.

 

Figure 8
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  		Fig. 2B —Focal nodular hyperplasia in asymptomatic 22-year-old woman. Arterial phase contrast-enhanced ultrasound (CEUS) images obtained with maximum-intensity-projection technique show superb vessel delineation. For video, see Figure S2 in supplemental data at www.ajronline.org. (Reprinted with permission from [35]) Sequential images obtained in arterial phase of CEUS show stellate vascularity, centrifugal filling, and homogeneous hypervascularity at peak enhancement (E).

 

Figure 9
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  		Fig. 2C —Focal nodular hyperplasia in asymptomatic 22-year-old woman. Arterial phase contrast-enhanced ultrasound (CEUS) images obtained with maximum-intensity-projection technique show superb vessel delineation. For video, see Figure S2 in supplemental data at www.ajronline.org. (Reprinted with permission from [35]) Sequential images obtained in arterial phase of CEUS show stellate vascularity, centrifugal filling, and homogeneous hypervascularity at peak enhancement (E).

 

Figure 10
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  		Fig. 2D —Focal nodular hyperplasia in asymptomatic 22-year-old woman. Arterial phase contrast-enhanced ultrasound (CEUS) images obtained with maximum-intensity-projection technique show superb vessel delineation. For video, see Figure S2 in supplemental data at www.ajronline.org. (Reprinted with permission from [35]) Sequential images obtained in arterial phase of CEUS show stellate vascularity, centrifugal filling, and homogeneous hypervascularity at peak enhancement (E).

 

Figure 11
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  		Fig. 2E —Focal nodular hyperplasia in asymptomatic 22-year-old woman. Arterial phase contrast-enhanced ultrasound (CEUS) images obtained with maximum-intensity-projection technique show superb vessel delineation. For video, see Figure S2 in supplemental data at www.ajronline.org. (Reprinted with permission from [35]) Sequential images obtained in arterial phase of CEUS show stellate vascularity, centrifugal filling, and homogeneous hypervascularity at peak enhancement (E).

 

Figure 12
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  		Fig. 2F —Focal nodular hyperplasia in asymptomatic 22-year-old woman. Arterial phase contrast-enhanced ultrasound (CEUS) images obtained with maximum-intensity-projection technique show superb vessel delineation. For video, see Figure S2 in supplemental data at www.ajronline.org. (Reprinted with permission from [35]) Image in portal venous phase at 3 minutes shows sustained contrast enhancement and central nonenhancing scar (arrow).

 

Figure 13
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  		Fig. 3A —Advantage of contrast-enhanced ultrasound (CEUS) for detection of liver metastases is shown in 72-year-old man with metastatic colon cancer. Baseline transverse sonogram shows gross steatosis and focal superficial mass in segment IV. Second tiny mass (arrow) may be present.

 

Figure 14
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  		Fig. 3B —Advantage of contrast-enhanced ultrasound (CEUS) for detection of liver metastases is shown in 72-year-old man with metastatic colon cancer. Portal venous phase CEUS image of known mass shows typical complete washout so that mass is now more conspicuous, appearing black, relative to enhanced parenchyma. Second smaller mass (arrow) is confirmed.

 

Figure 15
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  		Fig. 3C —Advantage of contrast-enhanced ultrasound (CEUS) for detection of liver metastases is shown in 72-year-old man with metastatic colon cancer. Sweep through liver shows two additional metastases in segment VI that are obvious here but were unsuspected on baseline scan (A).

 

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