Role of CEUS in Vascular Pathology

Abstract

In recent years, the implementation of contrast-enhanced ultrasound (CEUS) in clinical practice has opened new horizons in the arterial pathologies research field, since this technique is able to supply new sets of data that can be crucial in patient management. The main applications of CEUS in the arterial system are the detection, characterization, and follow-up of carotid plaques and endoleaks after EVAR. Other situations in which CEUS was demonstrated to be a useful tool are large vessel vasculitis, dissections, and untreated aneurysms. In carotid atherosclerosis CEUS is not only able to acquire quantitative data about stenosis but also to perform a qualitative assessment of the plaque. The most important plaque features that CEUS is able to depict are ulceration, neovascularization, and the presence of inflammatory infiltrates. All of these factors contribute to plaque vulnerability. Thus, CEUS is crucial in order to allow better risk stratification and management of patients. In follow-up after EVAR, CEUS shows sensitivity and specificity values similar to CTA while ensuring several advantages, such as lower cost and the absence of ionizing radiation and nephrotoxic agents. Moreover, CEUS is able to offer real-time evaluation of endoleaks and thus is a useful tool in cases that are ambiguous on CTA. Most limitations are patient-related and are the same as in all other ultrasound techniques, such as high BMI and meteorism.

New Technologies in the Assessment of Carotid Stenosis: Beyond the Color-Doppler Ultrasound—High Frame Rate Vector-Flow and 3D Arterial Analysis Ultrasound

“…In spite of the use of iodinated contrast agents and the exposure of the patient to ionizing radiation, CTA has several advantages over MRA for carotid imaging. CTA is less susceptible to artifacts than MRA, technical, and based on patients and calcium; other advantages over MRA include that CTA provides more accurate information about the surrounding anatomy, thus being useful in surgical planning, and it is far more widely available than MRI ( Table 1 ) [ 12 ].…”

“…CEUS uses an intra-vascular contrast agent consisting of microbubbles (1–8 µm) filled with perfluorinated gas with low solubility injected to acquire high contrast ultrasonic images of the carotid artery. It allows some limitations of DUS to be overcome, such as the detection of low blood flow and insonation of deep vessels ( Figure 5 ) [ 12 , 19 , 20 ].…”

The Technique and Advantages of Contrast-Enhanced Ultrasound in the Diagnosis and Follow-Up of Traumatic Abdomen Solid Organ Injuries

“…According to EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) guidelines, CEUS can be used as an alternative to computer tomography (CT) scans for hemodynamically stable patients with isolated, blunt, moderate-energy abdominal traumas to evaluate solid organ injury, particularly for children and for follow-ups of conservatively managed abdominal trauma to reduce the number of CT examinations [ 13 , 14 ]. Furthermore, CEUS has many other applications in studying parenchymatous and vessel non-traumatic pathologies [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ] and as a problem solving technique [ 24 ], and also in guiding abdominal interventional procedures [ 25 ].…”

Clinical Practice Report of Contrast‐Enhanced Ultrasound in Renal Artery Disease

“…However, conventional US assessment of renal arteries relies more on flow velocity than on direct visual imaging because it is difficult to show the whole process of renal artery satisfactorily for the patient-related limitations, such as high BMI and overlying bowel gas. 7 Contrastenhanced ultrasound (CEUS), which enhances blood echoes through intravenously injecting ultrasound contrast agent, can visualize the renal arteries more clearly than conventional US. In addition, this examination is non-invasive, non-radiation and without nephrotoxicity, and has attracted widespread attention in the evaluation of renal artery disease.…”

“…US is safe and readily available, and often used as a screening method. However, conventional US assessment of renal arteries relies more on flow velocity than on direct visual imaging because it is difficult to show the whole process of renal artery satisfactorily for the patient‐related limitations, such as high BMI and overlying bowel gas 7 . Contrast‐enhanced ultrasound (CEUS), which enhances blood echoes through intravenously injecting ultrasound contrast agent, can visualize the renal arteries more clearly than conventional US.…”