Contrast-enhanced ultrasound: clinical applications in patients with atherosclerosis

Abstract

Contrast-enhanced ultrasound (CEUS) is increasingly being used to evaluate patients with known or suspected atherosclerosis. The administration of a microbubble contrast agent in conjunction with ultrasound results in an improved image quality and provides information that cannot be assessed with standard B-mode ultrasound. CEUS is a high-resolution, noninvasive imaging modality, which is safe and may benefit patients with coronary, carotid, or aortic atherosclerosis. CEUS allows a reliable assessment of endocardial borders, left ventricular function, intracardiac thrombus and myocardial perfusion. CEUS results in an improved detection of carotid atherosclerosis, and allows assessment of high-risk plaque characteristics including intraplaque vascularization, and ulceration. CEUS provides real-time bedside information in patients with a suspected or known abdominal aortic aneurysm or aortic dissection. The absence of ionizing radiation and safety of the contrast agent allow repetitive imaging which is particularly useful in the follow-up of patients after endovascular aneurysm repair. New developments in CEUS-based molecular imaging will improve the understanding of the pathophysiology of atherosclerosis and may in the future allow to image and directly treat cardiovascular diseases (theragnostic CEUS). Familiarity with the strengths and limitations of CEUS may have a major impact on the management of patients with atherosclerosis.

Contrast-enhanced ultrasound with a novel nanoparticle contrast agent for clinical diagnosis in patients with non-small cell lung cancer

“…Notably, contrast-enhanced ultrasound is widely applied in the diagnosis of hypertrophic cardiomyopathy (21). Microbubbles are the most common used ultrasound contrast agent and provide a strongly reflective interface and resonate to ultrasound waves, which are easily observed (22). In the present study, an improved contrast-enhanced ultrasound administrated with a nanoparticle contrast agent aimed to improve image quality and resolution, thus improving the rate of early diagnosis of NSCLC compared with a standard ultrasound.…”

Carotid stenosis – basing treatment on individual patients’ needs. Optimal medical therapy alone or accompanied by stenting or endarterectomy

“…• Vulnerability of plaques can potentially be determined by advanced carotid imaging [11][12][13]. Irregular stenosis and plaques with endothelial defects are found to be associated with an increased risk of stroke, even in the long term [14][15][16][17].…”

“…These immature vessels increase the risk of intraplaque haemorrhage and plaque rupture. Therefore, intraplaque neovascularization is a reliable marker for plaque vulnerability [13]. A lipid rich necrotic core, intraplaque haemorrhage, and a thinning or rupture of the fi brous cap were found to be strongly associated with the risk of stroke or TIA (HR 3.0, 4.6, and 5.9, respectively) [20].…”

“…The fi lter is integrated distally into the post-dilation balloon catheter. Currently available EPDs are benefi cial in pre-Vasa (2018), 47 (1), [7][8][9][10][11][12][13][14][15][16] © 2017 Hogrefe venting large embolic particles from reaching the brain. However, MRI and TCD data show that despite the use of EPD, microemboli reach the middle cerebral artery in almost every intervention.…”

“…Vasa (2018), 47 (1), [7][8][9][10][11][12][13][14][15][16] © 2017 Hogrefe depending on stenosis severity (absolute risk reduction of ipsilateral stroke and operative stroke or death at fi ve years of -2.2 %, 3.2 %, 4.6 %, and 15.9 % in patients with < 30 %, 30-49 %, 50-69 %, and ≥ 70 % stenosis, respectively). In contrast, for patients without a history of stroke or TIA who are on OMT of current standard, the annual risk of cerebral infarction is low (0.3-2.9 % [4][5][6][7]).…”