Contrast-enhanced ultrasonography with Sonazoid™ for the evaluation of bowel ischemia

Abstract

Contrast-enhanced ultrasonography with Sonazoid™ is a highly sensitive and specific method for the diagnosis of bowel ischemia.

Gastrointestinal Ultrasound (GIUS) in Intestinal Emergencies – An EFSUMB Position Paper

“…Sonographic findings suggesting the need for surgery include intraperitoneal free fluid, bowel wall thickness > 4 mm, decreased or absent peristalsis in documented mechanical obstruction, absence or reduced bowel wall perfusion at Doppler sonography or with IV contrast-enhanced ultrasound (CEUS) and, in advanced stages free intraperitoneal gas indicating bowel perforation [27,35,[49][50][51]. However, after the encouraging preliminary results with the use of firstgeneration contrast agents, no further studies have confirmed whether CEUS can accurately detect ischemia in the presence of bowel strangulation [52][53][54]. Currently the authors acknowledge that these GIUS signs have low accuracy in predicting complicated SBO associated with critical ischemia and therefore CT scanning plays a more crucial role for this purpose.…”

Two-dimensional and contrast-enhanced ultrasound of intestinal ischaemia in cats: four cases

“…Intestinal ischaemia (IIS) is a potentially fatal event caused by various diseases and characterised by a rapidly progressive course leading to intestinal necrosis, both in humans and animals. [1][2][3][4] Acute arterial mesenteric thromboembolism secondary to hypertrophic cardiomyopathy, 3,5 trauma-associated mesenteric ischaemia, 6 bowel strangulation and ischaemia secondary to foreign body obstruction 7 have been reported in the veterinary literature. Clinical presentation is non-specific and includes vomiting and abdominal pain.…”

“…3 In humans, the gold standard for diagnosis of IIS is abdominal CT angiography (sensitivity: 82-96%; specificity: 94%) or magnetic resonance angiography. 1,2,[8][9][10][11] Abdominal ultrasonography (US) is commonly used in human and small animal patients with acute abdomen; however, this technique is not accurate when evaluating IIS. 1,2,5,8,12 Conventional Doppler US is not suitable for the evaluation of intestinal micro-perfusion because flow velocity and amplitude are too low to be detected, even in a normal intestine.…”

“…1,2,[8][9][10][11] Abdominal ultrasonography (US) is commonly used in human and small animal patients with acute abdomen; however, this technique is not accurate when evaluating IIS. 1,2,5,8,12 Conventional Doppler US is not suitable for the evaluation of intestinal micro-perfusion because flow velocity and amplitude are too low to be detected, even in a normal intestine. 1,8,13 Furthermore, severely increased peristalsis associated with abundant luminal gas may also complicate the feasibility of Doppler US.…”

“…1,2,5,8,12 Conventional Doppler US is not suitable for the evaluation of intestinal micro-perfusion because flow velocity and amplitude are too low to be detected, even in a normal intestine. 1,8,13 Furthermore, severely increased peristalsis associated with abundant luminal gas may also complicate the feasibility of Doppler US. On the contrary, several studies have demonstrated the accuracy of contrast-enhanced US (CEUS) for the detection of human IIS (sensitivity: 85-94.1%; specificity: 100%), characterised by reduced or absent colour signal on the affected intestinal wall after contrast medium (CM) injection.…”