超声造影结合Bosniak标准在良恶性肾囊性病变鉴别诊断中的价值

目的 评价超声造影鉴别良恶性肾囊性病变的准确性,探讨超声造影结合Bosniak标准分级诊断肾囊性病变的可行性.资料与方法 对30例患者的36个肾囊性病灶进行超声造影,分析良恶性肾囊性病变的超声造影征象;按照Bosniak标准对超声造影的表现进行分级诊断,计算其敏感性、特异性、诊断符合率、阳性预测值、阳性似然比、Kappa值及验后概率,分析该方法分级诊断肾囊性病变的准确性.结果 超声造影可显示常规超声不能发现的囊内分隔及实性结构.超声造影结合Bosniak标准诊断肾囊性病变的敏感性、特异性、诊断符合率、阳性预测值、阳性似然比分别为92.9％、90.9％、94.8％、86.7％、10.2,Kappa=0.83;应用超声造影结合Bosniak标准可提高肾囊性病变良恶性诊断的验后概率.结论 超声造影结合Bosniak标准可以提高鉴别诊断肾囊性病变良恶性的准确性.     

Contrast-enhanced ultrasound in evaluation of adrenal lesions with CT/MRI correlation

Most of the adrenal masses are incidentally detected. Multiphasic CT forms the mainstay for diagnosis and characterization of adrenal masses. MRI can further be used if the masses are indeterminate on CT scan. But as these investigations are expensive with risk of radiation exposure, contrast-enhanced ultrasound (CEUS) is currently under evaluation to assess its utility to act as a screening modality to differentiate benign vs malignant adrenal masses This investigative modality is relatively safe and can be used in patients having renal dysfunction or allergy to CT contrast. We, hereby, present a pictorial review of imaging appearance of various adrenal lesions on CEUS with CT and MRI correlation.     

超声造影与增强CT对肾癌的诊断分析

目的:本研究旨在比较超声造影(CEUS)和增强CT(CECT)在肾癌病灶中的诊断价值,探讨超声造影在肾癌的诊断价值。方法:对54例患者临床诊断为肾脏内占位性病灶进行CEUS和CECT检查,通过分析病灶CEUS和CECT的特点,比较两种方法的诊断效能。结果:54个病灶中34个为肾脏恶性肿瘤,20个为肾脏良性病灶,CEUS和CECT诊断敏感性、特异性、准确性、阳性预测值、阴性预测值分别为97.05%、85.0%、92.59%、91.67%、94.44%与91.18%、80.00%、87.04%、88.57%、84.21%。两种方法诊断差异无统计学意义(P>0.05)。结论:分析比较CEUS和CECT在诊断肾癌过程中,两种方法诊断效能无明显差异,均能为临床诊断提供重要依据,但CEUS对微循环灌注方面及假包膜的观察优于CECT;CEUS定量评价肾肿瘤血管现处于动物实验阶段,临床上特异指标的找寻仍有待于进一步研究。     

Feasability of real time contrast enhanced ultrasound in renal disease

OBJECTIVES: To evaluate feasibility of real-time contrast enhanced ultrasound in renal disease. MATERIALS AND METHODS: Eighteen patients (sex-ratio=1: mean age 62.3 +/-18.1 years) presenting with several renal diseases were enrolled in the present study. Real time contrast enhanced sonography was performed using an ultrasound dedicated system Esatune (Esaote, Firenze, Italy) with a very low mechanical index (MI<0.1) and a dedicated contrast software CnTI after bolus injection of 2.4 ml Sonovue (Bracco, Milan, Italy). Detection, characterization and extension of renal masses as well as inflammatory and ischemic lesions were evaluated. The results were compared to those obtained by reference method such as contrast-enhanced CT-Scan or MRI. RESULTS: This preliminary study gave some valuable results compared to baseline sonography: marked improvement in tumor delineation or internal microvasculature, detection of venous extension, improvement in cystic mass characterization. Diagnosis confidence was improved and reached 83% when diagnosis concordance with reference modality was improved by 50%. CONCLUSION: These preliminary results show that real-time contrast enhanced sonography could improve detection and characterization of renal masses by a complete assessment or arterial phase. Further studies are required to confirm these first results with possible advantages for the diagnosis of renal affections.     

Management of hepatocellular carcinoma: The role of contrast-enhanced Tultrasound简

Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third cause of cancer death worldwide. Contrast enhanced ultrasound (CEUS) has been applied for more than ten years and plays increasingly important roles in the management of HCC. On the basis of the Guideline and Good Clinical Practice Recommendations for CEUS in the liver-update 2012 and related literature about the management of HCC, we summarize the main roles and applications of CEUS in the management of HCC, including HCC surveillance, diagnosis, CEUS-guided treatment, treatment response evaluation and follow-up. The diagnostic algorithm for HCC is also suggested. Meanwhile, the comparisons between CEUS and contrast enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) in these areas are made. Although CEUS is subject to the same limitation as ordinary US and is inferior to CECT/CEMRI in some aspects, CEUS has proved to be of great value in the management of HCC with inherent advantages, such as sufficient high safety profile making it suitable for patients with renal failure or allergic to iodine, absence of radiation, easy reproducibility and high temporal resolution. The tremendous application of CEUS to the diagnosis and treatment of HCC provides more opportunities for patients with HCC diagnosed at different stages.     

Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US

OBJECTIVES: To compare retrospectively the imaging features of computed tomography (CT) and contrast-enhanced US (CEUS) imaging for the assessment of cystic renal masses using the Bosniak classification system. MATERIALS AND METHODS: The CT and CEUS images of 31 pathologically confirmed cystic renal masses in 31 patients were retrospectively analyzed for septa numbers, wall and/or septa thickness, enhancement degree, and for the presence of a solid component by consensus between two radiologists using the Bosniak classification. Diagnostic accuracies of CT and CEUS for malignant cystic tumor were calculated and compared using McNemar test. RESULTS: Diagnostic accuracies of CT and CEUS for malignant renal tumor were 74% and 90%, respectively, but there were not statistically different (P>0.05). CEUS and CT images showed same Bosniak classification in 23 (74%) lesions and there were differences in 8 (26%) lesions, all of which were upgraded by CEUS; one lesion from I to IV, two lesions from II to IV, two lesions from IIF to III, and three lesions from III to IV. CEUS images depicted more septa in 10 (32%) lesions, more thickened wall and/or septa in 4 (13%) lesions, and stronger enhancement in 19 (61%) lesions. Moreover, for six lesions, solid component was detected by CEUS but not by CT. CONCLUSION: CEUS might better visualize septa number, septa and/or wall thickness, solid component and the enhancement of some renal cystic masses than CT, resulting in upgrade of Bosniak classification and affecting their treatment plan.     

Microbubble ultrasound contrast agents: an update

Microbubble contrast agents for ultrasound (US) have gained increasing interest in recent years, and contrast-enhanced US (CEUS) is a rapidly evolving field with applications now extending far beyond the initial improvements achieved in Doppler US. This has been achieved as a result of the safe profile and the increased stability of microbubbles persisting in the bloodstream for several minutes, and also by the availability of specialized contrast-specific US techniques, which allow a definite improvement in the contrast resolution and suppression of signal from stationary tissues. CEUS with low transmit power allows real-time scanning with the possibility of prolonged organ insonation. Several reports have described the effectiveness of microbubble contrast agents in many clinical applications and particularly in the liver, spleen, and kidneys. CEUS allows the assessment of the macrovasculature and microvasculature in different parenchymas, the identification and characterization of hepatic and splenic lesions, the depiction of septal enhancement in cystic renal masses, and the quantification of organ perfusion by the quantitative analysis of the echo-signal intensity. Other fields of application include the assessment of abdominal organs after traumas and the assessment of vesico-ureteral reflux in children. Finally, tumor-targeted microbubbles make possible the depiction of specific biologic processes.     

Pancreatic multicenter ultrasound study (PAMUS)

Aim

To describe the typical CEUS pattern of pancreatic lesions and to evaluate the diagnostic accuracy of Contrast-enhanced ultrasound (CEUS) in their characterization.

Materials and methods

All US and CEUS examinations of focal pancreatic masses performed in six centers during a period of five years were reviewed. Inclusion criteria were: focal pancreatic mass pathologically proved, visible at ultrasound (US) and studied with CEUS. All lesions were then evaluated for size, aspect and enhancement pattern. Sensitivity, specificity, positive and negative predictive values with 95% CIs were calculated to define diagnostic accuracy of CEUS in respect to pathology. Diagnostic confidence of US and CEUS, discerning between benign and malignant lesions, were represented by using ROC (receiver operating characteristics) curves. Agreement was evaluated by means of k statistics.

Results

1439 pancreatic lesions were included. At CEUS the lesions were divided into solid (89%) and cystic (12%) masses and classified into six and eight categories, respectively. Among the solid lesions, adenocarcinomas were characterized with an accuracy of 87.8%. Among the cystic lesions, cystic tumors were diagnosed with an accuracy of 97.1%. ROC curve area increased from 0.637 for US to 0.877 for CEUS (p < 0.0001). Inter-observer agreement was slightly higher for solid (k = 0.78) than cystic (k = 0.62) lesions. In none of the centers side effects were reported.

Conclusion

CEUS is accurate in the characterization of pancreatic lesions. CEUS should be considered as a complementary imaging method for pancreatic lesions characterization.     

Analysis of comparative performance of CEUS and CECT/MR LI-RADS classification: Can CEUS dichotomize LI-RADS indeterminate lesions on CT or MRI?

PurposeTo study the comparative performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT or MRI (CECT/MR) in evaluating liver lesions using the LI-RADS guidelines.MethodsRetrospective analysis of radiology database from July 2010 to April 2017 revealed 228 patients who had CECT/MR and CEUS. Patients at risk of hepatocellular carcinoma (HCC), had contemporaneous CEUS and CECT/CEMR studies within 3 months and adequate follow up were included; reviewed (2 reviewers) and graded according to the 2017 CEUS and 2018 CECT/MR LI-RADS guidelines. Reference standard was multidisciplinary clinical decisions, histology or follow-up imaging.ResultsThe study cohort consisted of 45 patients with 46 lesions. HCC were significantly larger than non-malignant (mean sizes of 2.5 and 1.4 cm, respectively, p<0.001). Intraclass correlation coefficient for CEUS review (0.941) was higher than of CECT/MR review (0.643). Mean area-under-ROC curve (AUC) for CEUS (0.994) was significantly higher than of CECT/MR (0.760) for all lesions (p=0.01). For lesions scored LR-3 by CECT/MR, the AUC was significantly higher for CEUS (0.978) than CECT/MR (0.500) (p<0.001). Twenty-one (of 27) lesions, classified LR-3 or LR-4 by CECT/MR were upgraded by CEUS and 20 were found to be HCC. Six lesions that were LR-3 on both CECT/MR and CEUS were found to be non-malignant. There was good concordance for LR-5 lesions between both techniques.ConclusionCEUS is useful for reassessment of lesions with intermediate probability (LR-3) or probable for HCC (LR-4) on CECT/MR. Lesions upgraded by CEUS tend to be HCC. Lesions that remain LR-3 on CEUS tend to be non-malignant.     

Assessment of cystic renal masses in children: Comparison of multislice computed tomography and ultrasound imaging using the Bosniak classification system

To retrospectively compare contrast-enhanced multislice computed tomography (MSCT) and ultrasound (US) imaging for the assessment of cystic renal masses in children using the Bosniak classification system. Twenty-two consecutive patients (age 1 month to 5.2 years, mean 2.4 years) with 24 cystic renal masses (7 benign, 17 malignant) pathologically confirmed after surgical resection underwent both MSCT and US imaging, and were retrospectively analyzed using the Bosniak classification. A senior and a junior radiologist retrospectively and independently reviewed imaging findings. The sensitivity, specificity, positive predictive value and negative predictive values of MSCT and US were assessed using diagnostic statistics. The statistical significance of differences was determined by the McNemar test. Both radiologists accurately predicted lesions of categories I and IV with the Bosniak classification using MSCT and US. All masses classified as Bosniak classes I and II were proven to be benign, and all malignant lesions were correctly characterized in all cases both on ultrasound images and on the contrast-enhanced CT (CECT) images. Two benign multilocular cystic nephromas and one multicystic dysplastic kidney were classified into category III or even IV based on the classification scheme because of their multilocular nature and thick septation. The diagnostic accuracy of CECT was slightly better than ultrasound (CECT vs. US: senior reader, 92% vs. 88%; junior reader, 88% vs. 83%). However, there was no statistically significant difference between the two sets (p > 0.05). The two radiologists had perfect inter-observer agreement on the two modalities. Both MSCT and US provide highly accurate diagnosis for the malignant renal cystic masses in children using the Bosniak classification system, but assessment of benign masses still needs improvement. We would recommend US is the best screening modality in Bosniak I and II, In Bosniak III and IV, MSCT are first the choice.     

Enhancement patterns of intrahepatic cholangiocarcinoma: comparison between contrast-enhanced ultrasound and contrast-enhanced CT

The aim of this study was to compare the enhancement pattern of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) with that on contrast-enhanced computed tomography (CECT). 40 pathologically proven ICC lesions in 40 patients were evaluated retrospectively with both CEUS and CECT. The enhancement level and pattern in the dynamic phases on both CEUS and CECT were analysed. The diagnostic results of CEUS and CECT before pathological examination were also recorded. During arterial phases, the number of lesions that appeared as (i) peripheral irregular rim-like hyperenhancement, (ii) diffuse heterogeneous hyperenhancement, (iii) diffuse homogeneous hyperenhancement and (iv) diffuse heterogeneous hypoenhancement were 19 (47.5%), 9 (22.5%), 5 (12.5%) and 7 (17.5%), respectively, on CEUS, and 22 (55.0%), 3 (7.5%), 2 (5.0%) and 13 (32.5%), respectively, on CECT (p = 0.125). In the portal phase, the number of lesions showing hyperenhancement and hypoenhancement were 1 (2.5%) and 39 (97.5%), respectively, on CEUS, and 15 (37.5%) and 25 (62.5%) on CECT (p = 0.0001). CEUS made a correct diagnosis in 32 (80.0%) lesions before pathological examination; CECT made a correct diagnosis in 27 (67.5%) lesions (p = 0.18). In conclusion, the enhancement patterns of ICC on CEUS were consistent with those on CECT in the arterial phase, whereas in the portal phase ICC faded out more obviously on CEUS than on CECT. CEUS had the same accuracy as CECT in diagnosing ICCs, and so can be used as a new modality for the characterization of ICC.     

Contrast-enhanced ultrasound of the pancreas

The introduction of contrast-enhanced ultrasonography (CEUS) has led to major improvements in the diagnostic capabilities of ultrasound (US). The innovative use of CEUS for study of the pancreas has created the need for a definition of the most frequent dynamic features of solid and cystic masses. CEUS is less expensive compared to computed tomography and magnetic resonance imaging and is able to significantly improve the accuracy of US, allowing better characterization and staging of pancreatic pathologies.     

Sichere Diagnostik zystischer Nierenläsionen

Clinical/methodical issue

Cystic renal lesions are commonly seen during routine ultrasound examinations of the abdomen.

Standard radiological methods

Some cystic renal lesions cannot be sufficiently characterized using native ultrasound. In these cases additional imaging might be necessary.

Methodical innovations

Contrast-enhanced ultrasound (CEUS) is a reliable imaging modality to characterize cystic renal lesions. Contrast enhancement of septations and the cystic wall are visualized in high resolution. This information helps to categorize the cystic renal lesions applying the CEUS Bosniak classification. This classification helps to estimate the probability of a malignant etiology of cystic renal lesions.

Performance

Using CEUS, cystic renal lesions can be characterized with a high sensitivity and specificity.

Achievements

The advantages of CEUS include that there is no effect on the function of the kidneys or the thyroid gland and no radiation exposure. In some cases, additional cross-sectional imaging is necessary to optimize diagnostic accuracy.

Practical recommendations

CEUS is a helpful imaging modality to characterize cystic renal lesions, to avoid unnecessary follow-ups and to detect malignant cystic renal lesions.

     

Evaluating the perfusion of occupying lesions of kidney and bladder with contrast-enhanced ultrasound

PurposeTo evaluate the clinical diagnostic value of contrast-enhanced ultrasound (CEUS) for occupying lesions of kidney and bladder.Materials and MethodsCEUS was performed for a total of 50 kidney and bladder occupying lesions in 47 cases, and CEUS manifestations of these lesions were observed and analyzed. Patterns of dynamic changes in perfusion phases of CEUS were summarized and compared with results of postoperative pathology, enhanced computed tomography (CT), magnetic resonance imaging (MRI), and follow-ups.ResultsCEUS results showed that there were 22 cases of malignant renal tumors, 11 cases of benign lesions, two cases of renal column hypertrophy, and 12 cases of malignant bladder tumors (15 lesions). Renal cell carcinoma exhibited various CEUS manifestation, with the majority showing fast filling and hyper-enhancement. CEUS manifestation of renal hamartoma was characterized by slow filling and slow outflow. Renal cystic lesions always exhibited no enhancement within the cysts. Renal column hypertrophy exhibited the same enhancement pattern as the renal cortex. CEUS manifestation of bladder carcinoma was mainly characterized by quick filling, quick outflow, and hyperenhancement.ConclusionsCEUS offers real-time observation of perfusion in occupying lesions of kidney and bladder, but the enhancement pattern of kidney occupying lesions was complex; therefore, combination of enhanced CT, MRI, and CEUS may be necessary.     

超声造影在肝癌病灶诊断及引导射频消融治疗中的应用价值

目的探讨超声造影（CEUS）在肝恶性肿瘤病灶诊断及引导射频消融（RFA）治疗中的应用价值。方法对经病理确诊并经RFA治疗的56例肝癌患者资料进行回顾性分析,术前比较增强cT、普通彩色多普勒超声（二维＋多普勒）和超声造影对肝癌（原发及转移）的检出率,观察二维及超声造影病灶图像差异及特点。对普通彩色多普勒超声引导组（62个病灶）和超声造影引导组（so个病灶）在术中引导RFA的消融效果进行对比并利用超声造影观察射频消融术后疗效。结果56例肝癌患者,112个病灶（原发灶36个,转移灶76个）。超声造影对肝癌病灶检出率为94．6％（106／112）,增强CT对肝癌病灶检出率为96．4％（108／112）,两者检出率比较差异无统计学意义0（x^2=0．42,P〉O．05）。普通彩色多普勒超声对肝癌病灶检出率为74．1％（83／112）,其与超声造影的检出率差异有统计学意义0（2=16,P〈0．05）。在普通彩色多普勒超声引导下进行RFA完全消融率为69％（43／62）,超声造影引导下完全消融率为84％（42／50）,两者的完全消融率差异无统计学意义舒=1．6,P〉0．05）。结论超声造影在RFA术前对肝脏肿瘤的诊断,术中对病灶的准确定位及实时引导穿刺,术后对手术疗效的随访观察都具有重要的应用价值。     

Era of diagnostic and interventional ultrasound

It is an era of diagnostic and interventional ultrasound (US).Various new techniques such as three-dimensional US(3D US),interventional US,and contrastenhanced US(CEUS)have been introduced into clinical practice.Dr.Xu and his colleagues have taken advantage of these techniques and carried out a series of relevant studies.Their use of 3D US in the liver,gallbladder,liver tumor volumetry,guidance for ablation,and 3D CEUS has widened the application of 3D US in the clinic.They found that prognosis in patients with hepatocellular carcinoma(HCC)after thermal ablation with curative intent was determined by treatment response to ablation,pretreatment serum AFP,and liver function reserve.Tumor response to treatment was the most predictive factor for long-term survival.They compared the use of percutaneous microwave ablation and radiofrequency ablation for the treatment of HCC and found that both are effective methods in treating HCCs.The local tumor control,complications related to treatment, and long-term survival were equivalent for the two modalities.They first compared the enhancement patterns of HCC and intrahepatic cholangiocarcinoma(ICC)and proposed the diagnostic clues for ICC,liver angiomyolipoma(AML),gallbladder cancer,renal carcinoma,and renal AML,which have greatly enhanced the role ofCEUS in the clinic.They also evaluated the diagnostic performance of CEUS in characterizing complex cystic focal liver lesions and the agreement between two investigators with different experience levels;and found that CEUS is especially useful for the young investigator.They assessed the effect of anti-angiogenic gene therapy for HCC treated by microbubble-enhanced US exposure and concluded that gene therapy mediated by US exposure enhanced by a microbubble contrast agent may become a new treatment option for HCC.     

Evaluation of renal lesions using contrast-enhanced ultrasound (CEUS); a 10-year retrospective European single-centre analysis

Objective

To investigate the usefulness of contrast-enhanced ultrasound (CEUS) in the evaluation of renal masses.

Methods

This study included 255 patients with renal masses. Ages ranged from 18–86 years. CEUS was used for determining malignancy or benignancy and findings were correlated with the histopathological outcome. Out of 255 lesions, 212 lesions were malignant (83.1%) and 43 were benign (16.9%). Diagnostic accuracy was tested using the histopathological diagnosis as the gold standard.

Results

CEUS showed a sensitivity of 99.1% [95% confidence interval (CI): 96.7%, 99.9%], a specificity of 80.5% (CI: 65.1%, 91.2%), a positive predictive value of 96.4% (CI: 93.0%, 98.4%) and a negative predictive value of 94.3% (CI: 80.8%, 99.3%). Kappa for diagnostic accuracy was κ = 0.85 (CI: 0.75, 0.94). Of 212 malignant lesions, 200 renal cell carcinomas and 12 other malignant lesions were diagnosed. Out of 43 benign lesions, 10 angiomyolipomas, 3 oncocytomas, 8 renal cysts and 22 other benign lesions were diagnosed.

Conclusion

CEUS is an useful method to differentiate between malignant and benignant renal lesions. To date, to our knowledge, this is the largest study in Europe for the evaluation of renal lesions using CEUS with a histopathological validation.

Key Points

? CEUS helps clinicians detect and characterise unclear solid and cystic renal lesions ? CEUS shows a high diagnostic accuracy in the characterization of these lesions ? Proper surgical treatment or follow-up can be given with better diagnostic confidence

     

Focal liver lesions in cirrhosis: Role of contrast-enhanced ultrasonography

Contrast-enhanced ultrasound (CEUS) represents a great innovation for the evaluation of focal liver lesions (FLLs). The main advantage of CEUS is the real-time imaging examination and the very low toxicity in patients with renal failure. Liver cirrhosis has been recognized as a major risk factor for the onset of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). HCC in liver cirrhosis develops as the last step of a complex that leads to the gradual transformation from regenerative nodule through dysplastic nodule to HCC. In patients with liver cirrhosis, a surveillance program is recommended consisting of ultrasound (US) for detecting small focal lesions. A wide spectrum of benign and malignant lesions other than HCC may be found in the cirrhotic liver and their differentiation is important to avoid errors in staging diseases that may preclude potentially curative therapies. Several published studies have explored the value of CEUS in liver cirrhosis and they have been shown to have excellent diagnostic and prognostic performances for the evaluation of non-invasive and efficient diagnosis of FLLs in patients at high risk for liver malignancies. The purpose of this article is to describe and discuss CEUS imaging findings of FLLs including HCC and ICC, all of which occur in cirrhotic livers with varying prevalence.     

Moderne Bildgebung von Nierentumoren – Anwendung in Diagnostik und Therapie

This article elucidates the various tools used for the diagnostics and characterization of renal lesions. The advantages and limitations of ultrasound, contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) are presented and discussed. In addition, modern imaging features of CT and MRI, such as iodine quantification in CT as well as diffusion-weighted and perfusion imaging in MRI are presented. Lastly, recent developments in standardized reporting of renal tumors regarding the intraoperative surgical risk are presented.     

Effectiveness and safety of CEUS-guided haemostatic injection for blunt splenic trauma: an animal experiment

The aim of this study was to investigate whether complications occur after haemostatic agents are injected into blunt splenic injuries. After undergoing ultrasound (US), contrast-enhanced US (CEUS) and contrast-enhanced computed tomography (CECT) examinations, dogs with grade III?CIV injury received the minimally invasive therapy. After treatment, CEUS was performed to observe changes in the regions treated. In the immediate group, dogs underwent laparotomy 30 min after treatment to observe the haemostatic effect. In the survival group, animals underwent CEUS and CECT examinations to observe the short-term healing outcome and complications at 3, 7, 14, and 21 days after the injection. After undergoing CEUS and CECT examinations, 12 dogs with grade III-IV injury received the minimally invasive therapy. Before injection, CEUS examinations showed anechoic and/or hypoechoic perfusion defects and active bleeding at the injury sites, and CECT showed traumatic lesions as low-density regions without enhancement. After treatment, CEUS demonstrated the disappearance of active bleeding, and hyperechoic spots emerged at the injury sites. Uneven density regions were displayed on CECT. Treated areas were covered by blood clots and glue membrane in the immediate-group animals. Three weeks later, CEUS showed a decrease of hyperechoic spots in the survival group, and the splenic parenchyma enhanced uniformly on CECT. Laparotomy showed that the greater omentum had moved upwards and partly covered the wound in four animals, and the injury sites had completely healed. Histopathological examination showed that fibrous connective tissue covered the splenic capsule and that the haemostatic glue had degraded. No complication occurred, such as delayed splenic haemorrhage, splenic abscesses, splenic pseudoaneurysms, intestinal obstruction or intestinal adhesions. CEUS-guided haemostatic injection is not only effective in stopping active bleeding immediately, but it is also safe in that no complications occurred during the 3 weeks of follow-up. This study indicates that CEUS-guided percutaneous injection may provide a safe, feasible and effective therapy for blunt splenic trauma.