Oral and IV Contrast Enhanced Ultrasonography of the digestive tract – a useful completion of the B-mode examination: a literature review and an exhaustive illustration through images

Abstract

Contrast enhanced ultrasonography, using IV and/or oral/rectal contrast agents, represents a technical development of the US method, which has proved its applicability in the qualitative and quantitative assessment of the normal and pathological circulatory bed, as well as of the digestive lumen. The use of microbubbles and harmonics opens a new horizon in the detection and characterization of the inflammatory and tumoral conditions of the digestive tract. The interpretation of the data requires corroboration with the grey scale aspect of the examined lesion/area, as well as with the clinical context of the case and the results of other diagnosis techniques. The purpose of this paper is to review the main applications of CEUS in digestive tract pathology by analyzing the significant literature and guidelines in the light of our personal experience and demonstrating it through suggestive images.

A Rare Case of Spontaneous Gastrobiliary Fistula Diagnosed by Oral Contrast-enhanced Ultrasound

“…Oral contrast-enhanced gastric ultrasonography has been used in the detection and evaluation of gastric tumors and inflammatory bowel diseases [18,19]. Oral administration allows better visualization of the digestive lumen, especially in the upper gastrointestinal tract [20]. It improves diagnostic performance in discriminating gastric masses compared with conventional ultrasound [21,22].…”

Clinical value of oral contrast-enhanced ultrasonography in diagnosis of gastric tumors

“…Gastric wall thickness is an important parameter for ultrasound diagnosis of gastric cancer[ 11 ]. In patients with gastric cancer, the manifestations mainly include thickening of low echo of the gastric wall, ulceration, mass formation, disturbance of the five layers, and interruption of the continuity[ 12 ]. In contrast, gastric ulcers usually show localized hypoechoic wall thickening, uneven or depressed mucosal surface, and hyperechoic lines on the mucosal surface, along with air retention at the bottom[ 13 ].…”

Noninvasive Evaluation of Microcirculation under Normal and Pathological Conditions Using Contrast-Enhanced Ultrasonography (CEUS)

“…The applications in the pathology of the digestive tract and its glands are numerous and diverse. One of these is the quantification of the intestinal wall vascularity in patients with Crohn's disease [47,48]. In this particular situation, where angiogenesis is the key element of active disease, CEUS allows the assessment of the intestinal wall as well as of the adjacent fat, the results being strongly correlated with those of the MR [49].…”