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Contrast-Enhanced Ultrasound (CEUS) in Neurosurgery


Contrast-enhanced ultrasound (CEUS) is a harmonic imaging technique that permits to study tissue perfusion and vascularization using a purely intravascular ultrasound contrast agent (UCA). CEUS is a real-time, dynamic, continuous, and repeatable modality, applicable in neurosurgery for tumors and vessels study. In oncological surgery, CEUS permits to highlight and characterize the lesion through the study of its micro- and macro-circulation. Moreover, it allows to assess the degree of tumor removal and to plan the surgical strategy, highlighting the lesion feeders, drainage vessels, and neighboring vital vascular structures. In vascular surgery, CEUS permits to study the entire vascular tree from arteries, through capillaries, to veins simultaneously without the need to set multiple parameters. It also allows to assess vessel location, dimension, and flow entity and direction without the need of vessel direct exposure, being CEUS a tomographic representation. This leads to protect vital structures preservation and also to evaluate the effect of a procedure on the blood circulation.


  • Contrast Enhancement
  • Arterial Phase
  • Venous Phase
  • Ultrasound Contrast Agent
  • Sulfur Hexafluoride

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  1. Piscaglia F, Nolsoe C, Dietrich CF, Cosgrove DO, Gilja OH, Bachmann Nielsen M, Albrecht T, Barozzi L, Bertolotto M, Catalano O, Claudon M, Clevert DA, Correas JM, D’Onofrio M, Drudi FM, Eyding J, Giovannini M, Hocke M, Ignee A, Jung EM, Klauser AS, Lassau N, Leen E, Mathis G, Saftoiu A, Seidel G, Sidhu PS, ter Haar G, Timmerman D, Weskott HP (2012) The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med (Stuttgart, Germany: 1980) 33(1):33–59. doi:10.1055/s-0031-1281676

    CAS  CrossRef  Google Scholar 

  2. Prada F, Del Bene M, Moiraghi A, Casali C, Legnani FG, Saladino A, Perin A, Vetrano IG, Mattei L, Richetta C, Saini M, DiMeco F (2015) From grey scale B-mode to elastosonography: multimodal ultrasound imaging in meningioma surgery—pictorial essay and literature review. BioMed Res Int 2015:13. doi:10.1155/2015/925729

    CrossRef  Google Scholar 

  3. Prada F, Perin A, Martegani A, Aiani L, Solbiati L, Lamperti M, Casali C, Legnani F, Mattei L, Saladino A, Saini M, DiMeco F (2014) Intraoperative contrast-enhanced ultrasound for brain tumor surgery. Neurosurgery 74(5):542–552. doi:10.1227/neu.0000000000000301; discussion 552

    CrossRef  PubMed  Google Scholar 

  4. Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW (2007) Patterns of contrast enhancement in the brain and meninges. RadioGraphics 27(2):525–551. doi:10.1148/rg.272065155

    CrossRef  PubMed  Google Scholar 

  5. EMA (2014) SonoVue -EMEA/H/C/000303 -II/0025.

  6. Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsoe CP, Piscaglia F, Wilson SR, Barr RG, Chammas MC, Chaubal NG, Chen MH, Clevert DA, Correas JM, Ding H, Forsberg F, Fowlkes JB, Gibson RN, Goldberg BB, Lassau N, Leen EL, Mattrey RF, Moriyasu F, Solbiati L, Weskott HP, Xu HX (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. Ultraschall Med (Stuttgart, Germany: 1980) 34(1):11–29. doi:10.1055/s-0032-1325499

    CAS  Google Scholar 

  7. Prada F, Del Bene M, Saini M, Ferroli P, DiMeco F (2015) Intraoperative cerebral angiosonography with ultrasound contrast agents: how I do it. Acta Neurochir 157(6):1025–1029. doi:10.1007/s00701-015-2412-x

    CrossRef  PubMed  Google Scholar 

  8. Prada F, Mattei L, Del Bene M, Aiani L, Saini M, Casali C, Filippini A, Legnani FG, Perin A, Saladino A, Vetrano IG, Solbiati L, Martegani A, DiMeco F (2014) Intraoperative cerebral glioma characterization with contrast enhanced ultrasound. BioMed Res Int 2014:9. doi:10.1155/2014/484261

    CrossRef  Google Scholar 

  9. van Leyen K, Klotzsch C, Harrer JU (2011) Brain tumor imaging with transcranial sonography: state of the art and review of the literature. Ultraschall Med (Stuttgart, Germany: 1980) 32(6):572–581. doi:10.1055/s-0031-1273443

    CrossRef  Google Scholar 

  10. Prada F, Del Bene M, Mattei L, Lodigiani L, DeBeni S, Kolev V, Vetrano I, Solbiati L, Sakas G, DiMeco F (2014) Preoperative magnetic resonance and intraoperative ultrasound fusion imaging for real-time neuronavigation in brain tumor surgery. Ultraschall Med (Stuttgart, Germany: 1980). doi:10.1055/s-0034-1385347

    Google Scholar 

  11. Piscaglia F, Bolondi L (2006) The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 32(9):1369–1375. doi:10.1016/j.ultrasmedbio.2006.05.031

    CrossRef  PubMed  Google Scholar 

  12. Gibbs V, Cole D, Sassano A (2009) Ultrasound physics and technology. Elsevier, Churchill Livingstone

    Google Scholar 

  13. Quaia E (2011) Assessment of tissue perfusion by contrast-enhanced ultrasound. Eur Radiol 21(3):604–615. doi:10.1007/s00330-010-1965-6

    CrossRef  PubMed  Google Scholar 

  14. Engelhardt M, Hansen C, Eyding J, Wilkening W, Brenke C, Krogias C, Scholz M, Harders A, Ermert H, Schmieder K (2007) Feasibility of contrast-enhanced sonography during resection of cerebral tumours: initial results of a prospective study. Ultrasound Med Biol 33(4):571–575. doi:10.1016/j.ultrasmedbio.2006.10.007

    CrossRef  PubMed  Google Scholar 

  15. He W, Jiang XQ, Wang S, Zhang MZ, Zhao JZ, Liu HZ, Ma J, Xiang DY, Wang LS (2008) Intraoperative contrast-enhanced ultrasound for brain tumors. Clin Imaging 32(6):419–424. doi:10.1016/j.clinimag.2008.05.006

    CrossRef  PubMed  Google Scholar 

  16. Holscher T, Ozgur B, Singel S, Wilkening WG, Mattrey RF, Sang H (2007) Intraoperative ultrasound using phase inversion harmonic imaging: first experiences. Neurosurgery 60(4 Suppl 2):382–386. doi:10.1227/01.neu.0000255379.87840.6e; discussion 386–387

    PubMed  Google Scholar 

  17. Kanno H, Ozawa Y, Sakata K, Sato H, Tanabe Y, Shimizu N, Yamamoto I (2005) Intraoperative power Doppler ultrasonography with a contrast-enhancing agent for intracranial tumors. J Neurosurg 102(2):295–301. doi:10.3171/jns.2005.102.2.0295

    CrossRef  PubMed  Google Scholar 

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Correspondence to Massimiliano Del Bene MD .

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Prada, F., Del Bene, M., DiMeco, F. (2016). Contrast-Enhanced Ultrasound (CEUS) in Neurosurgery. In: Prada, F., Solbiati, L., Martegani, A., DiMeco, F. (eds) Intraoperative Ultrasound (IOUS) in Neurosurgery. Springer, Cham.

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