Skip to main content
SpringerLink
Log in

Contrast-Enhanced Ultrasonography: Clinical Applications

  • Chapter
  • First Online:
Ultrasonography of the Head and Neck

Abstract

Contrast-enhanced ultrasound (CEUS) is an emerging diagnostic technique that combines the use of a contrast agent with established ultrasound techniques. CEUS allows analysis of perfusion patterns in greater detail than conventional sonographic modalities. Though most applications in the head and neck remain off-label, many studies report an improvement of diagnostic accuracy by using CEUS in the head and neck, and there appear to be a variety of promising applications for future clinical routines.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Chung YE, Kim KW. Contrast-enhanced ultrasonography: advance and current status in abdominal imaging. Ultrasonography. 2014;34:3–18.

    Article  Google Scholar 

  2. Claudon M, Dietrich C, Choi B, Cosgrove D, Kudo M, Nolsøe C, et al. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2012. Ultraschall Med. 2013;34:11–29.

    Article  CAS  Google Scholar 

  3. Nolsøe CP, Lorentzen T. International guidelines for contrast-enhanced ultrasonography: ultrasound imaging in the new millennium. Ultrasonography. 2016;35:89–103.

    Article  Google Scholar 

  4. Piscaglia F, Nolsøe C, Dietrich C, Cosgrove D, Gilja O, Bachmann Nielsen M, et al. The EFSUMB guidelines and recommendations on the clinical practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med. 2012;33:33–59.

    Article  CAS  Google Scholar 

  5. Meltzer RS. Food and Drug Administration ultrasound device regulation: the output display standard, the “mechanical index,” and ultrasound safety. J Am Soc Echocardiogr. 1996;9:216–20.

    Article  CAS  Google Scholar 

  6. von Herbay A, Haeussinger D, Gregor M, Vogt C. Characterization and detection of hepatocellular carcinoma (HCC): comparison of the ultrasound contrast agents SonoVue (BR 1) and Levovist (SH U 508A). Ultraschall Med. 2007;28:168–75.

    Article  Google Scholar 

  7. Blomley MJK, Cooke JC, Unger EC, Monaghan MJ, Cosgrove DO. Science, medicine, and the future: Microbubble contrast agents: a new era in ultrasound. BMJ. 2001;322:1222.

    Article  CAS  Google Scholar 

  8. Burns PN. Basics. In: Weskott H-P, editor. Contrast-enhanced ultrasound. 2nd ed. Bremen: UNI-MED; 2013. p. 16–24.

    Google Scholar 

  9. Lindner JR. Microbubbles in medical imaging: current applications and future directions. Nat Rev Drug Discov. 2004;3:527–33.

    Article  CAS  Google Scholar 

  10. Qin S, Caskey CF, Ferrara KW. Ultrasound contrast microbubbles in imaging and therapy: physical principles and engineering. Phys Med Biol. 2009;54:R27–57.

    Article  Google Scholar 

  11. Postema M, Gilja OH. Contrast-enhanced and targeted ultrasound. World J Gastroenterol. 2011;17:28–41.

    Article  Google Scholar 

  12. Ignee A, Atkinson NSS, Schuessler G, Dietrich CF. Ultrasound contrast agents. Endosc Ultrasound. 2016;5:355–62.

    Article  Google Scholar 

  13. Solivetti FM, Elia F, Musicco F, Bonagura AC, Di Leo N, Iera J, et al. Anaphylactic shock induced by sulphur hexafluoride in an individual with no history of heart disease: case report and literature review. Ultraschall Med. 2012;33:597–8.

    Article  CAS  Google Scholar 

  14. Torres A, Koskinen SK, Gjertsen H, Fischler B. Contrast-enhanced ultrasound using sulfur hexafluoride is safe in the pediatric setting. Acta Radiol. 2017;58:1395–9.

    Article  Google Scholar 

  15. Torzilli G. Adverse effects associated with SonoVue® use. Expert Opin Drug Saf. 2005;4:399–401.

    Article  CAS  Google Scholar 

  16. Tang C, Fang K, Guo Y, Li R, Fan X, Chen P, et al. Safety of sulfur hexafluoride microbubbles in sonography of abdominal and superficial organs: retrospective analysis of 30,222 cases. J Ultrasound Med. 2017;36:531–8.

    Article  Google Scholar 

  17. Appis AW, Tracy MJ, Feinstein SB. Update on the safety and efficacy of commercial ultrasound contrast agents in cardiac applications. Echo Res Pract. 2015;2:R55–62.

    Article  Google Scholar 

  18. Dumitriu D, Dudea SM, Botar-Jid C, Baciut G. Ultrasonographic and sonoelastographic features of pleomorphic adenomas of the salivary glands. Med Ultrason. 2010;12:175–83.

    PubMed  Google Scholar 

  19. Pinkston J, Cole P. Incidence rates of salivary gland tumors: results from a population-based study. Otolaryngol Head Neck Surg. 1999;120:834–40.

    Article  CAS  Google Scholar 

  20. David E, Cantisani V, De Vincentiis M, Sidhu PS, Greco A, Tombolini M, et al. Contrast-enhanced ultrasound in the evaluation of parotid gland lesions: an update of the literature. Ultrasound. 2016;24:104–10.

    Article  CAS  Google Scholar 

  21. Gou JM, Chen Q, Zhou Q, Liu YX. Quantitative diagnosis of salivary gland tumors with contrast-enhanced ultrasound--a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:784–90.

    Article  Google Scholar 

  22. Küstermeyer J, Klingelhöfer G, Welkoborsky H-J. [Analysis of perfusion parameters within salivary gland tumors using contrast enhanced ultrasound]. [Article in German]. Laryngorhinootologie. 2016;95:688–93.

    Article  Google Scholar 

  23. Knopf A, Mansour N, Chaker A, Bas M, Stock K. Multimodal ultrasonographic characterisation of parotid gland lesions--a pilot study. Eur J Radiol. 2012;81:3300–5.

    Article  Google Scholar 

  24. Fischer T, Paschen C, Slowinski T, Alkhameri A, Berl J, Klingebiel R, et al. Differentiation of parotid gland tumors with contrast-enhanced ultrasound. Fortschr Röntgenstr. 2009;182:155–62.

    Article  Google Scholar 

  25. Pinkston JA, Cole P. Cigarette smoking and Warthin’s tumor. Am J Epidemiol. 1996;144:183–7.

    Article  CAS  Google Scholar 

  26. Zengel P, Berghaus A, Weiler C, Reiser M, Clevert DA. Intraductally applied contrast-enhanced ultrasound (IA-CEUS) for evaluating obstructive disease and secretory dysfunction of the salivary glands. Eur Radiol. 2011;21:1339–48.

    Article  Google Scholar 

  27. Siedek V, Rytvina M, Klotz LV, Berghaus A, Clevert D-A, Strieth S. Validation of contrast-enhanced ultrasound-derived intensity-time gradients in submandibular gland sialolithotomy patients. Eur Arch Otorhinolaryngol. 2013;270:1941–6.

    Article  Google Scholar 

  28. Wei X, Li Y, Zhang S, Li X, Wang H, Yong X, et al. Evaluation of microvascularization in focal salivary gland lesions by contrast-enhanced ultrasonography (CEUS) and Color Doppler sonography. Clin Hemorheol Microcirc. 2013;54:259–71.

    CAS  PubMed  Google Scholar 

  29. Klotz LV, Ingrisch M, Eichhorn ME, Niemoeller O, Siedek V, Gürkov R, et al. Monitoring parotid gland tumors with a new perfusion software for contrast-enhanced ultrasound. Clin Hemorheol Microcirc. 2014;58:261–9.

    PubMed  Google Scholar 

  30. Badea AF, Bran S, Tamas-Szora A, Floareş A, Badea R, Baciut G. Solid parotid tumors: an individual and integrative analysis of various ultrasonographic criteria. A prospective and observational study. Med Ultrason. 2013;15:289–98.

    Article  Google Scholar 

  31. Moritz JD, Ludwig A, Oestmann J-W. Contrast-enhanced color doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors. Am J Roentgenol. 2000;174:1279–84.

    Article  CAS  Google Scholar 

  32. Schade G. [Experiences with using the ultrasound contrast medium Levovist in differentiation of cervical lymphomas with color-coded duplex ultrasound]. [Article in German]. Laryngorhinootologie. 2001;80:209–13.

    Article  CAS  Google Scholar 

  33. Jecker P, Engelke JC, Westhofen M. [Possible application of a signal enhancer for duplex ultrasound in otorhinolaryngology]. [Article in German]. Laryngorhinootologie. 2008;77:289–93.

    Article  Google Scholar 

  34. Dudea SM, Lenghel M, Botar-Jid C, Vasilescu D, Duma M. Ultrasonography of superficial lymph nodes: benign vs. malignant. Med Ultrason. 2012;14:294–306.

    PubMed  Google Scholar 

  35. Zenk J, Bozzato A, Steinhart H, Greess H, Iro H. Metastatic and inflammatory cervical lymph nodes as analyzed by contrast-enhanced color-coded Doppler ultrasonography: quantitative dynamic perfusion patterns and histopathologic correlation. Ann Otol Rhinol Laryngol. 2005;114:43–7.

    Article  Google Scholar 

  36. Schulte-Altedorneburg G, Demharter J, Linné R, Droste DW, Bohndorf K, Bücklein W. Does ultrasound contrast agent improve the diagnostic value of colour and power Doppler sonography in superficial lymph node enlargement? Eur J Radiol. 2003;48:252–7.

    Article  Google Scholar 

  37. Schröder RJ, Mäurer J, Hidajat N, Willam C, Hell B, Weber S, et al. [Signal-enhanced color-coded duplex sonography of reactively and metastatically enlarged lymph nodes]. [Article in German]. Rofo. 1998;168:57–63.

    Article  Google Scholar 

  38. Rubaltelli L, Khadivi Y, Tregnaghi A, Stramare R, Ferro F, Borsato S, et al. Evaluation of lymph node perfusion using continuous mode harmonic ultrasonography with a second-generation contrast agent. J Ultrasound Med. 2004;23:829–36.

    Article  Google Scholar 

  39. Yu M, Liu Q, Song HP, Han ZH, Su HL, He GB, et al. Clinical application of contrast-enhanced ultrasonography in diagnosis of superficial lymphadenopathy. J Ultrasound Med. 2010;29:735–40.

    Article  Google Scholar 

  40. Dudau C, Hameed S, Gibson D, Muthu S, Sandison A, Eckersley RJ, et al. Can contrast-enhanced ultrasound distinguish malignant from reactive lymph nodes in patients with head and neck cancers? Ultrasound Med Biol. 2014;40:747–54.

    Article  Google Scholar 

  41. Weskott H-P. Ultrasound in the diagnostic management of malignant lymphomas. Radiologe. 2012;52:347–59.

    Article  Google Scholar 

  42. Nakase K, Yamamoto K, Hiasa A, Tawara I, Yamaguchi M, Shiku H. Contrast-enhanced ultrasound examination of lymph nodes in different types of lymphoma. Cancer Detect Prev. 2006;30:188–91.

    Article  Google Scholar 

  43. Rübenthaler J, Lutz J, Reiser M, Clevert DA. [Paraganglioma of the head and neck: follow-up of interventional procedures with CEUS]. [Article in German]. Ultraschall Med. 2015;36:541–3.

    Article  Google Scholar 

  44. Küstermeyer J, Deichmüller CC, Albers M, Graß SK, Welkoborsky HJ. Quantifizierung des präoperativen Embolisationseffektes bei Glomus caroticum Tumoren durch kontrastverstärkte Sonographie. [Abstract.] 88th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery; 2017. https://doi.org/10.3205/17hno088.

  45. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133.

    Article  Google Scholar 

  46. Nemec U, Nemec SF, Novotny C, Weber M, Czerny C, Krestan CR. Quantitative evaluation of contrast-enhanced ultrasound after intravenous administration of a microbubble contrast agent for differentiation of benign and malignant thyroid nodules: assessment of diagnostic accuracy. Eur Radiol. 2012;22:1357–65.

    Article  Google Scholar 

  47. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules--2016 update. Endocr Pract. 2016;22:622–39.

    Article  Google Scholar 

  48. Argalia G, De Bernardis S, Mariani D, Abbattista T, Taccaliti A, Ricciardelli L, et al. Ultrasonographic contrast agent: evaluation of time-intensity curves in the characterisation of solitary thyroid nodules. Radiol Med. 2002;103:407–13.

    CAS  PubMed  Google Scholar 

  49. Bartolotta TV, Midiri M, Galia M, Runza G, Attard M, Savoia G, et al. Qualitative and quantitative evaluation of solitary thyroid nodules with contrast-enhanced ultrasound: initial results. Eur Radiol. 2006;16:2234–41.

    Article  Google Scholar 

  50. Spiezia S, Farina R, Cerbone G, Assanti AP, Iovino V, Siciliani M, et al. Analysis of color Doppler signal intensity variation after Levovist injection: a new approach to the diagnosis of thyroid nodules. J Ultrasound Med. 2001;20:223–31.

    Article  CAS  Google Scholar 

  51. Jin L, Xu C, Xie X, Li F, Lv X, Du L. An algorithm of image heterogeneity with contrast-enhanced ultrasound in differential diagnosis of solid thyroid nodules. Ultrasound Med Biol. 2017;43:104–10.

    Article  Google Scholar 

  52. Cantisani V, Consorti F, Guerrisi A, Guerrisi I, Ricci P, Di Segni M, et al. Prospective comparative evaluation of quantitative-elastosonography (Q-elastography) and contrast-enhanced ultrasound for the evaluation of thyroid nodules: preliminary experience. Eur J Radiol. 2013;82:1892–8.

    Article  CAS  Google Scholar 

  53. Friedrich-Rust M, Sperber A, Holzer K, Diener J, Grünwald F, Badenhoop K, et al. Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp Clin Endocrinol Diabetes. 2010;118:602–9.

    Article  CAS  Google Scholar 

  54. Jiang J, Shang X, Zhang H, Ma W, Xu Y, Zhou Q, et al. Correlation between maximum intensity and microvessel density for differentiation of malignant from benign thyroid nodules on contrast-enhanced sonography. J Ultrasound Med. 2014;33:1257–63.

    Article  Google Scholar 

  55. Molinari F, Mantovani A, Deandrea M, Limone P, Garberoglio R, Suri JS. Characterization of single thyroid nodules by contrast-enhanced 3-d ultrasound. Ultrasound Med Biol. 2010;36:1616–25.

    Article  Google Scholar 

  56. Zhang Y, Luo Y-K, Zhang M-B, Li J, Li J, Tang J. Diagnostic accuracy of contrast-enhanced ultrasound enhancement patterns for thyroid nodules. Med Sci Monit. 2016;22:4755–64.

    Article  Google Scholar 

  57. Li F, Wang Y, Bai B, Wang S, Liu S. Advantages of routine ultrasound combined with contrast-enhanced ultrasound in diagnosing papillary thyroid carcinoma. Ultrasound Q. 2017;33:213–8.

    Article  Google Scholar 

  58. Zhou X, Zhou P, Hu Z, Tian SM, Zhao Y, Liu W, et al. Diagnostic efficiency of quantitative contrast-enhanced ultrasound indicators for discriminating benign from malignant solid thyroid nodules. J Ultrasound Med. 2017;22:4755.

    Google Scholar 

  59. Ma J-J, Ding H, Xu B-H, Xu C, Song L-J, Huang B-J, et al. Diagnostic performances of various gray-scale, color Doppler, and contrast-enhanced ultrasonography findings in predicting malignant thyroid nodules. Thyroid. 2014;24:355–63.

    Article  Google Scholar 

  60. Schleder S, Janke M, Agha A, Schacherer D, Hornung M, Schlitt HJ, et al. Preoperative differentiation of thyroid adenomas and thyroid carcinomas using high resolution contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc. 2015;61:13–22.

    Article  CAS  Google Scholar 

  61. Williams R, Hudson JM, Lloyd BA, Sureshkumar AR, Lueck G, Milot L, et al. Dynamic microbubble contrast-enhanced US to measure tumor response to targeted therapy: a proposed clinical protocol with results from renal cell carcinoma patients receiving antiangiogenic therapy. Radiology. 2011;260:581–90.

    Article  Google Scholar 

  62. Lassau N, Lamuraglia M, Vanel D, Le Cesne A, Chami L, Jaziri S, et al. Doppler US with perfusion software and contrast medium injection in the early evaluation of isolated limb perfusion of limb sarcomas: prospective study of 49 cases. Ann Oncol. 2005;16:1054–60.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, KRH Nordstadt Clinic–Academic Hospital, Hannover, Germany

    Julian Küstermeyer

Authors
  1. Julian Küstermeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julian Küstermeyer .

Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, KRH Nordstadt Clinic-Academic Hospital, Hannover, Germany

    Hans J. Welkoborsky

  2. Department of Otorhinolaryngology and Plastic Head and Neck Surgery, Klinikum Bad Salzungen GmbH, Bad Salzungen, Germany

    Peter Jecker

16.1 Electronic Supplementary Material

Pleomorphic adenoma (MP4 20782 kb)

Warthin’s tumor (MP4 24857 kb)

Reactive lymph node (MP4 23120 kb)

Carcinoma metastasis (MP4 31294 kb)

Paraganglioma (MP4 15637 kb)

Thyroid nodules (MP4 21089 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Küstermeyer, J. (2019). Contrast-Enhanced Ultrasonography: Clinical Applications. In: Welkoborsky, H., Jecker, P. (eds) Ultrasonography of the Head and Neck. Springer, Cham. https://doi.org/10.1007/978-3-030-12641-4_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-12641-4_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12640-7

  • Online ISBN: 978-3-030-12641-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation