Sidhu Paul S, Clevert Dirk Andre, Deganello Annamaria, Piskunowicz Maciej, Cantisani Vito, Fischer Thomas
Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK.
Insights Imaging. 2025 Aug 15;16(1):179. doi: 10.1186/s13244-025-02055-w.
The use of contrast-enhanced ultrasound (CEUS) in clinical practice is theoretically limited to the licensed indications: focal liver lesions, breast, peripheral arterial system, and the heart. In reality, there has been a continuous expansion of the deployment of CEUS examinations to many other organs and body parts over the last 20 years. Many of these applications are a natural extension of the diagnostic capabilities of the CEUS examination, used to achieve a better imaging outcome. These applications have been supported by guidelines issued by scientific societies, detailing the application, accuracy, and safety of the clinical performance. Nevertheless, there are some areas in which it remains more difficult to establish the use of CEUS in the diagnostic pathway. In the pregnant patient, CEUS is an ideal examination-a natural extension of B-mode ultrasound, avoiding ionising radiation and iodinated contrast. The contrast agents used in ultrasound do not cross the placental barrier. Ultrasound in the paediatric patient is used widely, and extending this to a CEUS examination improves diagnostic capabilities, avoiding less child-friendly imaging techniques. The parent can be in the room at the time of the ultrasound examination. Other aspects of CEUS usage are hampered by the lack of physician engagement despite the proven advantages of the technique, the reduction in the morbidity associated with CT and MR imaging, particularly the contrast agents used in these modalities. Complex renal cyst classification, follow-up of blunt abdominal trauma and the surveillance following placement of an aortic stent graft are all areas of potential benefit to the diagnosis. All these are better imaged on a CEUS examination. Furthermore, cost savings can be achieved using CEUS, mostly by alleviating downstream costs of CT and MR imaging. CRITICAL RELEVANCE STATEMENT: CEUS use outside licensed uses is becoming established, driven by the unique ability to achieve diagnostic standards safely and with patient acceptability, pushing the boundaries in areas of abdominal trauma, pregnancy, paediatrics, aortic implants, and complex renal cysts. KEY POINTS: CEUS has a narrow range of licensed applications in medical imaging, but is used widely. An exclusively intravascular agent allows assessment of vascular flow at the capillary level. CEUS is extremely safe and can be used in many areas that require repeated high-resolution imaging.
在临床实践中，超声造影（CEUS）的使用理论上仅限于获批的适应症：肝脏局灶性病变、乳腺、外周动脉系统和心脏。实际上，在过去20年里，CEUS检查的应用范围不断扩大，已涵盖许多其他器官和身体部位。其中许多应用是CEUS检查诊断能力的自然延伸，用于获得更好的成像效果。这些应用得到了科学协会发布的指南的支持，这些指南详细说明了临床应用的方法、准确性和安全性。然而，在某些领域，要在诊断流程中确立CEUS的应用仍较为困难。对于孕妇，CEUS是一种理想的检查——是B超的自然延伸，可避免电离辐射和含碘造影剂。超声使用的造影剂不会穿过胎盘屏障。儿科患者中超声应用广泛，将其扩展到CEUS检查可提高诊断能力，避免使用对儿童不太友好的成像技术。超声检查时家长可以在检查室。尽管CEUS技术有已被证实的优势，但由于医生参与度不足，其使用的其他方面受到了阻碍，CT和MR成像（尤其是这些检查所使用的造影剂）相关的发病率有所降低。复杂肾囊肿的分类、钝性腹部创伤的随访以及主动脉支架植入后的监测都是CEUS诊断可能带来益处的领域。所有这些在CEUS检查中都能获得更好的成像。此外，使用CEUS可以节省成本，主要是通过减轻CT和MR成像的下游成本。关键相关性声明：在安全且患者可接受的情况下，CEUS独特的达到诊断标准的能力推动了其在腹部创伤、妊娠、儿科、主动脉植入物和复杂肾囊肿等领域的应用边界，促使其在获批用途之外的使用逐渐确立。要点：CEUS在医学成像中的获批应用范围较窄，但使用广泛。一种仅用于血管内的造影剂可在毛细血管水平评估血流情况。CEUS极其安全，可用于许多需要重复进行高分辨率成像的领域。
