Abdominal Radiology

, Volume 43, Issue 4, pp 808–818 | Cite as

How to set up a contrast-enhanced ultrasound service

  • Stefanie Weinstein
  • Eric Jordan
  • Ruth Goldstein
  • Judy Yee
  • Tara Morgan
Invited article

This paper will provide practical details and useful information on how to establish a contrast-enhanced ultrasound (CEUS) service safely and efficiently. It is meant to be an introduction to CEUS focusing on how to implement ultrasound contrast into a clinical service rather than on specific clinical applications. Ultrasound contrast agents have been in use throughout most of the world and have been used off-label in the United States for over a decade. In addition to the use of ultrasound contrast agents in cardiac imaging, the FDA recently approved their use in liver imaging for both pediatric and adult patients, and for use in the urinary tract (voiding ultrasonography) in pediatric patients for evaluation of suspected or known vesicoureteral reflux (VUR) [1, 2, 3, 4, 5, 6, 7, 8]. With recent FDA approvals, even wider adaption of CEUS is expected.


Contrast-enhanced ultrasound has an excellent safety profile. Since the contrast agents are excreted by the lungs they are...


Compliance with ethical standards


No funding was obtained for this study.

Conflict of interest

The authors have no conflict of interest to disclose.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Lumason (sulfur hexafluoride lipid –type A microspheres) for injectable suspension full Perscribing Information. Monoroe Township, N.B.D.I.M.
  2. 2.
    Optison (perflutren protein-type A microspheres) for injectable suspension full prescribing information. Malborough MA: GE Healthcare, M.
  3. 3.
    Definitiy (perflutren protein-type A microspheres) for injectable suspension full prescribing Information, N.B., MA: Lantheus Medical Imaging; April 2013.
  4. 4.
    Barr R (2017) How to develop a contrast-enhanced ultrasound program. J Ultrasound Med 36:1225–1240CrossRefPubMedGoogle Scholar
  5. 5.
    Radmayr C, Klauser A, Pallwein L, et al. (2002) Contrast-enhanced reflux sonography in children: a comparison to standard radiological imaging. J Urol 167(3):1428–1430CrossRefPubMedGoogle Scholar
  6. 6.
    Darge K, Troeger J (2002) Vesicoureteral reflux grading in contrast-enhanced voiding urosonography. Eur J Radiol 43(2):122–128CrossRefPubMedGoogle Scholar
  7. 7.
    Papadopoulou F, Anthopoulou A, Siomou E, et al. (2009) Harmonic voiding urosonography with a second-generation contrast agent for the diagnosis of vesicoureteral reflux. Pediatr Radiol 39(3):239–244CrossRefPubMedGoogle Scholar
  8. 8.
    Fernández-Ibieta M, Parrondo-Muiños C, Fernández-Masaguer LC, et al. (2016) Voiding urosonography with second-generation contrast as a main tool for examining the upper and lower urinary tract in children. Pilot Study. Actas Urol Esp 40(3):183–189CrossRefPubMedGoogle Scholar
  9. 9.
    Greis C (2004) Technology overview. SonoVue (Bracco, Milan). Eur Radiol 14:11–15CrossRefGoogle Scholar
  10. 10.
    Claudon M, et al. (2013) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver—update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 39(2):187–210CrossRefPubMedGoogle Scholar
  11. 11.
    Barr RG, Peterson C, Hindi A (2014) Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 271(1):133–142CrossRefPubMedGoogle Scholar
  12. 12.
    Piscaglia F, Nolsoe C, Dietrich CF, et al. (2012) The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultra-schall Med 33:33–59CrossRefGoogle Scholar
  13. 13.
    Quaia E, Bertolotto M, Cioffi V, Rossi A, et al. (2008) Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR 191(4):1239–1249CrossRefPubMedGoogle Scholar
  14. 14.
    Leen E, Ceccotti P, Kalogeropoulou C, et al. (2006) Prospective multicenter trial evaluating a novel method of characterizing focal liver lesions using contrast-enhanced sonography. AJR 186:1551–1559CrossRefPubMedGoogle Scholar
  15. 15.
    Ding H, Wang WP, Huang BJ (2005) Imaging of focal liver lesions low-mechanical-index real-time ultrasonography with SonoVue. J Ultrasound Med 24:285–297CrossRefPubMedGoogle Scholar
  16. 16.
    Quaia E, Degobbis F, Tona G, et al. (2004) Differential patterns of contrast enhancement in different focal liver lesions after injection of the microbubble US contrast agent SonoVue [in English and Italian]. Radiol Med 107:155–165PubMedGoogle Scholar
  17. 17.
    Wilson SR, Jang HJ, Kim TK, Burns PN (2007) Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans. J Ultrasound Med 26:775–787CrossRefPubMedGoogle Scholar
  18. 18.
    Karthikesalingam A, Al-Jundi E, Jackson D, et al. (2012) Systematic review and meta-analysis of duplex ultrasonography, contrast-enhanced ultrasonography or computed tomography for surveillance after endovascular aneurysm repair. J Surg 99(11):1514–1523Google Scholar
  19. 19.
    Carrafiello G, Recaldini C, Lagana D, Piffaretti G, Gugazzola C (2008) Endoleak detection and classification after treatment of abdominal aortic aneurysm: value of CEUS over CTA. Abdom Imaging 33(3):357–362CrossRefPubMedGoogle Scholar
  20. 20.
    Horje CHT, Bruijnen R, Roovers L, et al. (2015) Contrast-enhanced Abdominal ultrasound in the assessment of ileal inflammation in Crohn’s disease: a comparison with MR enterography. PLoS One. 10(8):e0136105CrossRefGoogle Scholar
  21. 21.
    Quaia E, Cabibbo B, De Paoli L, et al. (2013) The value of time-intensity curves obtained after microbubble contrast agent injection to discriminate responders from non-responders to anti-inflammatory medication among patients with Crohn’s disease. Eur Radiol 23(6):1650–1659CrossRefPubMedGoogle Scholar
  22. 22.
    Quaia E, Migaleddu V, Baratella E, et al. (2009) The diagnostic value of small bowel wall vascularity after sulfur hexafluoride-filled microbubble injection in patients with Crohn’s disease. Correlation with the therapeutic effectiveness of specific anti-inflammatory treatment. Eur J Radiol 69(3):438–444CrossRefPubMedGoogle Scholar
  23. 23.
    De Franco A, Di Veronica A, Armuzzi A, et al. (2012) Ileal Crohn disease: mural microvascularity quantified with contrast-enhanced US correlates with disease activity. Radiology 262(2):680–688CrossRefPubMedGoogle Scholar
  24. 24.
    Averkiou M, Bruce M, Jensen S, Rafter P, Brock-Fisher T, Powers J. Pulsing schemes for the detection of nonlinear echoes from contrast microbubbles. In:Proceedings of the 9th European Symposium on Ultrasound Contrast Iaging 2004; Rotterdam, The Netherlands.Google Scholar
  25. 25.
    King KG, Gulati M, Harshawn M, et al. (2015) Quantitative assessment of solid renal masses by contrast-enhanced ultrasound with time-intensity curves: how we do it. Abdom Imaging 40:2461–2471CrossRefPubMedGoogle Scholar
  26. 26.
    Aoki S, Hattori R, Yamamoto T, Funahashi , et al. (2010) Contrast-enhanced ultrasound using a time-intensity curve for the diagnosis of renal cell carcinoma. BHUI 108:349–354Google Scholar
  27. 27.
    Cai Y, Du L, Li F, et al. (2014) Quantification of enhancement of renal parenchymal masses with contrast-enhanced ultrasound. Ultrasound Med Biol 40(7):1387–1393CrossRefPubMedGoogle Scholar
  28. 28.
    Barr RG (2013) Off-label use of ultrasound contrast agents for abdominal imaging in the United States. J Ultrasound Med 32:7–12CrossRefPubMedGoogle Scholar
  29. 29.
  30. 30.
    Wei K, Mulvagh SL, Carson L, et al. (2008) The safety of definity and optison for ultrasound image enhancement: a retrospective analysis of 78,383 administered contrast doses. J Am Soc Echocardiogr 21(11):1202–1206CrossRefPubMedGoogle Scholar
  31. 31.
    Piscaglia F, Bolondi L (2006) The safety of Sonovue in abdominal applications: retrospective analysis of 23,188 investigations. Ultrasound Med Biol 32(9):1369–1375CrossRefPubMedGoogle Scholar
  32. 32.
    Coleman JL, Navid F, Furman WL, McCarville MB (2014) Safety of ultrasound contrast agents in the pediatric oncologic population: a single-institution experience. AJR Am J Roentgenol 202(5):966–970CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Nolsoe CP, Lorentzen T (2016) International guidelines for contrast-enhanced ultrasonography: ultrasound imaging in the new millennium. Ultrasonography 35:89–103CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Stefanie Weinstein
    • 1
  • Eric Jordan
    • 1
  • Ruth Goldstein
    • 1
  • Judy Yee
    • 1
  • Tara Morgan
    • 1
  1. 1.Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoUSA

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