Contrast-Enhanced Endoscopic Ultrasound with Low Mechanical Index: A New Technique

Abstract

Recent advances in technology have supported the development of new echo-endoscopic systems making it possible to use real-time, low mechanical index, contrast-enhanced imaging techniques with endoscopic ultrasound. We have preliminarily shown that arterial, portal venous and parenchymal contrast enhancement is possible.

EFSUMB guidelines 2015 on interventional ultrasound

“…In combination with fine-needle aspiration using curved linear-array instruments, and with the use of Doppler, contrast enhanced endoscopic ultrasound [26,82,83], and elastography, EUS has finally become a state-of-theart, minimally invasive alternative to exploratory surgery in many situations-not only for diagnostic but also for therapeutic purposes.…”

Contrast-enhanced endoscopic ultrasound for pancreatobiliary disease

“…5,[8][9][10] On the other hand, intra-lesional slow-flowing vessels can be better demonstrated by contrast harmonic imaging without Doppler-related artifacts owing to its ability to detect the second harmonic signals of the contrast agents more strongly than the background signal of the target lesion. 5,[11][12][13] The technique of CEH EUS was made possible by the use of second generation ultrasound contrast agents such as SonoVue (Bracco Imaging, Milan, Italy) and Sonazoid (DaiichiSankyo, Tokyo, Japan), which can produce harmonic signals at lower acoustic power generated by the transducers on the modern electronic echoendoscopes. 5,[11][12][13] Contrast harmonic imaging technique has become the mainstay in modern CE EUS.…”

Ultrasonography of the biliary tract – up to date. The importance of correlation between imaging methods and patients’ signs and symptoms.

“…The CA can be introduced alse into the bile ducts, either by injection during percutaneous drainage procedures or by a adminstration through drainage tubes, in this situation having an ultrasonographic "fistulography" character [11]. CEUS may be combined with endoscopic ultrasonography (CE -CEUS), using a high MI or low MI, the latter being similar to transabdominal CEUS [12,13]. Combination with spectral Doppler analysis, can detect the presence of arterioles within pancreatic ducts adenocarcinomas, an aspect that allows a better angiographic perfusion analysis [14].…”

“…It consists of using elastic high frequency (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) probes attached on the guiding wire, probes introduced through the operative channel of the endoscope and then through the papilla inside the main bile duct [15]. The round image, resulted from the continuous rotation of the transducer, allows the visualisation of the ductal wall stratification at a resolution close to that of the microscope.…”