Contrast‐Enhanced Colosonography for the Evaluation of Children With an Imperforate Anus

This case series describes a novel method for showing the preoperative anatomy of children with anorectal malformations using ultrasound contrast, which we have termed “contrast‐enhanced colosonography (ceCS).” Six patients with anorectal malformations without a perineal fistula were studied both by fluoroscopic distal colostography and ceCS, and their results were confirmed surgically. Contrast‐enhanced CS precisely showed the complex anatomic relationships in all cases. Compared to traditional fluoroscopic studies, ceCS has the benefit of no associated ionizing radiation and thus is safer for children.     

How to Develop a Contrast‐Enhanced Ultrasound Program

With the recent Food and Drug Administration approval of Lumason (sulfur hexafluoride lipid‐type A microsphere, Bracco Diagnostics Inc, Monroe Township, NJ) for contrast‐enhanced ultrasound (CEUS) to characterize focal liver lesions in both adult and pediatric patients, widespread use of CEUS is expected in the United States. This paper provides guidance in setting up a CEUS program, and reviews the practical details that will need to be instituted in a standard ultrasound department to provide both safe and efficient use of CEUS. A review of the indications, contraindications, adverse events, instructions for performing the exam, and image interpretation are discussed.     

Contrast‐Enhanced Ultrasound Guidance for Interventional Procedures

Since its introduction, contrast‐enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast‐enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast‐enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound‐guided interventions in the abdomen and pelvis.     

Contrast‐Enhanced Sonographic Characteristics of Hepatic Inflammatory Pseudotumors

A hepatic inflammatory pseudotumor, which can be misdiagnosed as a malignant tumor, is a relatively uncommon tumor with nonspecific imaging manifestations. As a new diagnostic technique, contrast‐enhanced sonography has become increasingly important in the diagnosis of liver focal lesions. Here we present 3 cases of histologically confirmed hepatic inflammatory pseudotumors diagnosed with contrast‐enhanced sonography. “Fast‐in and centrifugal‐out” may be a characteristic contrast‐enhanced sonographic enhancement pattern in the diagnosis of hepatic inflammatory pseudotumors, which needs confirmation in further studies.     

Behavior of Hepatocellular Adenoma on Real‐time Low‐Mechanical Index Contrast‐Enhanced Ultrasonography With a Second‐Generation Contrast Agent

Objective. The purpose of this study was to describe the behavior of histologically proven hepatocellular adenoma (HCA) on low‐mechanical index (MI) contrast‐enhanced ultrasonography (CEUS). Methods. A review of the databases from 4 academic hospitals revealed 18 patients (15 female and 3 male; mean age, 40 years; range, 25–71 years) with 25 histologically proven HCA lesions who were studied with CEUS at a low MI (0.04–0.1). Results. Twenty‐four of 25 lesions (96%; 95% confidence interval [CI], 80.5%–99.3%) showed high‐intensity enhancement, scored as 3 on a scale of 0 to 3, whereas only 1 lesion (4%; 95% CI, 0.7%–19.5%) was scored as 2. The time of peak enhancement ranged between 10 and 19 seconds (average, 13 seconds). All but 1 of the 25 lesions (96%; 95% CI, 80.5%–99.3%) showed early homogeneous and centripetal enhancement during the hepatic arterial phase. No portal venous phase enhancement was observed in any lesion because all showed rapid wash‐out (100%; 95% CI, 86.7%–100%). Twenty lesions (80%; 95% CI, 60.9%–91.1%) were found to be isoechoic to slightly hypoechoic during the portal phase, and 19 (76%; 95% CI, 56.6%–88.5%) were isoechoic to mildly hypoechoic, whereas 7 (24%; 95% CI, 11.5%–43.4%) were hypoechoic during the late phase. Conclusions. Contrast‐enhanced ultrasonography is an effective technique for identifying the microvascular and macrovascular characteristics of HCA. Typically, HCA shows early (10–19 seconds) and centripetal enhancement during the arterial phase and isoechogenicity or mild hypoechogenicity during the portal phase, remaining slightly hypoechoic or isoechoic during the late phase in most cases.     

Contrast‐Enhanced Sonographically Guided Thermal Ablation for Treatment of Solid‐Organ Hemorrhage

The purpose of this series was to preliminarily evaluate the use of contrast‐enhanced sonographically guided percutaneous thermal ablation in the evaluation and treatment of solid‐organ bleeding by retrospectively analyzing 6 cases observed in clinical practice. Six patients who underwent contrast‐enhanced sonographically guided thermal ablation for treatment of solid‐organ bleeding (5 in liver and 1 in spleen) from December 2005 to August 2012 were included in this series. Clinical information, contrast‐enhanced sonograms before and after ablation, and the ablation method were retrospectively collected and analyzed. In 5 of the 6 patients, the location of the bleeding lesion was clearly seen. Hemostasis was successfully achieved in 4 of these 5 patients: 1 by radiofrequency ablation and 3 by microwave ablation. Ablation failed to achieve hemostasis in 1 patient who had postbiopsy splenic arterial bleeding because the bleeding vessel was a thick branch of the splenic artery. In the sixth remaining patient, who had bleeding after liver biopsy, hemostasis failed because contrast‐enhanced sonography did not precisely locate the bleeding lesion; hence, the ablation zone did not cover the whole lesion. Contrast‐enhanced sonographically guided ablation can be an alternative choice for treating solid‐organ bleeding because of its effectiveness and minimal invasiveness. However, it should be carefully investigated for those in whom the bleeding lesion cannot be located by contrast‐enhanced sonography and in those who have bleeding in a large vessel.