Endocavitary Contrast-Enhanced Ultrasound

Abstract

Background Ultrasound is one of the most important imaging methods in the daily routine. Contrast-enhanced ultrasound (CEUS) has put ultrasound on equal footing with computed tomography and magnetic resonance imaging in many areas. Although ultrasound contrast agents are commonly administered intravenously, endocavitary application as performed in the case of iodine-containing contrast agents is also possible.

Method Based on the current literature, this overview provides information regarding possible endocavitary applications of ultrasound contrast agents as they are used and could be used in the daily routine in radiology. Examples are provided to illustrate the advantages and disadvantages of clinical use.

Results and Conclusion Endocavitary CEUS broadens the spectrum of possible ultrasound applications and can be safely used for patient diagnosis and treatment. The method can be safely used for diagnosis and patient management, particularly in patients in whom examinations including exposure to radiation with iodine-containing contrast agents may be contraindicated and who have limited mobility due to disease severity.

Key points: 

• Endocavitary CEUS is a safe method that can be readily learned by those with prior ultrasound training. Radiologists benefit from their existing knowledge of contrast-enhanced imaging.

• With ultrasound contrast agents, endocavitary examinations comparable to CT and fluoroscopy can be performed without having to take radiation exposure, preexisting conditions, and patient mobility into consideration.

• In principle, endocavitary CEUS can access every body cavity (physiological and pathological) and body orifice with any access device.

• The method is mainly used for interventions including puncture and drainage. The diluted ultrasound contrast agent can be continuously visualized in the access device and in the target region, including distribution within the target region, with high spatial and temporal resolution. Voiding urosonography and visualization of the salivary duct system should also be mentioned in the radiological context.

• Poor B-mode imaging conditions typically also mean poor CEUS conditions. Imaging methods that can reliably evaluate low-lying structures and structures with overlying air, particularly in obese patients, without artifacts and can provide a good overview have a clear advantage here.

Citation Format

• Vollert K, Clevert DA, Kleffel T. Endocavitary Contrast-Enhanced Ultrasound. Fortschr Röntgenstr 2022; 194: 1204 – 1214

Key words

contrast enhanced ultrasound - endocavitary - diagnostic ultrasound - interventional ultrasound - contrast agents

Publication History

Received: 31 October 2021

Accepted: 05 March 2022

Article published online:
17 August 2022

• References

• 1 Dietrich CF, Nolsøe CP, Richard G. et al. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2020. Ultraschall in Med 2020; 41: 562-585
• 2 Sidhu PS, Cantisani V, Dietrich CF. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall in Med 2018; 39: e2-e44
• 3 Quaia E. Microbubble ultrasound contrast agents: an update. Eur Radiol 2007; 17 (08) 1995-2008
• 4 Cosgrove D. Ultrasound contrast agents: an overview. Eur J Radiol 2006; 60 (03) 324-330
• 5 Farina R. et al. Vesico-ureteral reflux: diagnosis and staging with voiding color Doppler US: preliminary experience. Eur J Radiol 2000; 35: 49-53
• 6 Fachinformation Sonovue, Bracco, Mailand, Italien.
• 7 Piscaglia F, Bolondi F. et al. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 2006; 32: 1369-1375
• 8 Ignee A, Schuessler G, Cui XW. et al. Der endocavitäre Kontrastmittelultraschall-verschiedene Anwendungen, eine Übersicht über die Literatur und zukünftige Perspektiven. Ultraschall in Med 2013; 34: 504-528
• 9 Huang DY, Yusuf GT, Daneshi M. et al. Contrast-enhanced US–guided Interventions: Improving Success Rate and Avoiding Complications Using US Contrast Agents. RadioGraphics 2017; 37: 652-664
• 10 Huang DY, Yusuf GT, Daneshi M. et al. Contrast-enhanced ultrasound (CEUS) in abdominal intervention. Abdom Radiol 2018; 43: 960-976
• 11 Darge K. Voiding urosonography with ultrasound contrast agents for the diagnosis of vesicoureteric reflux in children. I. Procedure. Pediatr Radiol 2008; 38: 40-45
• 12 Papadopoulou F, Ntoulia A, Siomou E. et al. Contrast-enhanced voiding urosonography with intravesical administration of a second-generation ultrasound contrast agent for diagnosis of vesicoureteral reflux: prospective evaluation of contrast safety in 1,010 children. Pediatr Radiol 2014; 44: 719-728
• 13 Riccabona M, Vivier PH, Ntoulia A. et al. ESPR Uroradiology Task Force. ESPR uroradiology task force imaging recommendations in paediatric uroradiology part VII. Standardized terminology, impact of existing recommendations, and update on contrast-enhanced ultrasound of the paediatric urogenital tract. Pedidatr Radiol 2014; 44: 1478-1484
• 14 Capaccio P, Minetti AM, Manzo R. et al. Int J Maxillo Odontostomatol 2003; 2: 9-12
• 15 Zengel P, Schrötzlmair F, Kramer M. et al. Management of salivary gland diseases with contrast-enhanced ultrasound. Radiologe 2011; 51 (06) 490-496
• 16 Zengel P, Berghaus A, Paprottka P. et al. Sonographic analyses of obstructive diseases of the salivary gland using intraductal applications of contrast agent, Laryngorhinootologie. 2011; 90 (04) 196-199
• 17 Zengel P, Berghaus A, Weiler C. et al. Intraductally applied contrast-enhanced ultrasound (IA-CEUS) for evaluating obstructive disease and secretory dysfunction of the salivary glands. Eur Radiol 2011; 21 (06) 1339-1348
• 18 Zengel P, Schrötzlmair F, Reichel C. et al. Sonography: the leading diagnostic tool for diseases of the salivary glands. Semin Ultrasound CT MR 2013; 34 (03) 196-203
• 19 Sparchez Z, Radu P, Sparchez M. et al. Intracavitary Applications of Ultrasound Contrast Agents in Hepatogastroenterology. J Gastrointestin Liver Dis 2013; 22 (03) 349-353
• 20 Schäfer AO, Baumann T, Langer M. MRT in der Diagnostik anorektaler Fisteln. RöFo 2006; 178 (11) 1095-1104
• 21 Chen YJ, Mao R, Xie XH. et al. Intracavitary Contrast-enhanced Ultrasonography to Detect Enterovesical Fistula in Crohns Disease. Gastroenterology 2016; 150: 315-317
• 22 Heinzmann A, Muller T, Leitlein J. et al. Endocavity contrast enhanced ultrasound (CEUS) – work in progress. Ultraschall in Med 2012; 33: 76-84
• 23 Mahnken A, Thomas C, Wilhelm K. Hrsg. Interventionelle Radiologie. 1. Aufl.. Stuttgart: Thieme; 2019.
• 24 Daneshi M, Rajayogeswaran B, Peddu P. et al. Demonstration of an occult biliary-arterial fistula using percutaneous contrast-enhanced ultrasound cholangiography in a transplanted liver. J Clin Ultrasound 2014; 42 (02) 108-111
• 25 Huang DY, Yusuf GT, Daneshi M. et al. Contrast-enhanced ultrasound (CEUS) in abdominal intervention. Abdom Radiol 2018; 43: 960-976
• 26 Yusuf GT, Fang C, Huang DY. et al. Endocavitary contrast enhanced ultrasound (CEUS): a novel problem solving technique. Insights into Imaging 2018; 9: 303-311
• 27 Zhou L, Zhang X, Chen X. et al. Value of three-dimensional hysterosalpingo-contrast sonography with SonoVue in the assessment of tubal patency. Ultrasound Obstet Gynecol 2012; 40 (01) 93-98
• 28 Kloth C, Kratzer W, Schmidberger J. et al. Ultraschall 2020 – Diagnostik & Therapie: Auf dem Weg zur multimodalen Sonografie: kontrastverstärkter Ultraschall (CEUS), mikrovaskuläre Dopplerverfahren, Fusionsbildgebung, Sono-Elastografie, interventionelle Sonografie. RöFo 2021; 193 (01) 23-32
• 29 Jung EM, Jung F, Stroszcynski C. Dynamic endoluminal contrast enhanced ultrasound (CEUS) for display of drainages in inflammatory abdominal fluid collections. Clin Hemorheol Microcirc 2022;
• 30 Young A, Yusuf G, Fang C. Cholecystoduodenal fistula identified on oral contrast-enhanced ultrasound. J Ultrasound 2020;
• 31 Foschi F, Piscaglia F, Pompili M. Real-time contrast-enhanced ultrasound--a new simple tool for detection of peritoneal-pleural communications in hepatic hydrothorax. Ultraschall in Med 2008 Oct 29 (05) 538-542
• 32 Francica G. Intracavitary contrast‑enhanced ultrasound in ultrasound‑guided percutaneous management of abdominal fluid collections/abscessesby a single clinician: an example of point‑of‑care ultrasound. Journal of Ultrasound 2020; 23: 175-181
• 33 Fischer T. „CEUS ist kein Hexenwerk“. RöFo 2018; 190 (05) 462-464
• 34 Graeter T, Kratzer W, Seufferlein T. Erhebung der Wertigkeit der kontrastverstärkten Sonografie (CEUS) in radiologischen Fachabteilungen in Deutschland. Fortschr Röntgenstr 2017; 189: 748-759