Download PDF
Radiologie up2date 2018; 18(02): 123-152
DOI: 10.1055/a-0578-5287
Gerätetechniken/Neuentwicklungen/Digitale Radiologie
Georg Thieme Verlag KG Stuttgart · New York

Grundlagen der kontrastverstärkten Sonografie (CEUS)

Basics of contrast enhanced ultrasound
Holger Strunk
,
Milka Marinova
Further Information

Publication History

Publication Date:
29 June 2018 (online)

Also available at
    Permissions and Reprints All articles of this category

Zusammenfassung

Die kontrastverstärkte Sonografie (CEUS) wird für viele Fragestellungen und in zahlreichen Fachdisziplinen eingesetzt, wenn auch mit unterschiedlichen Indikationen und Schwerpunkten. Dabei spielt die Erfahrung des Untersuchers sowohl für die Befunderhebung als auch für die Befundbeurteilung eine wesentliche Rolle. Im Folgenden werden die Grundlagen und die wichtigsten Einsatzgebiete der CEUS dargestellt.

Abstract

In this article the basics of contrast-enhanced sonography (CEUS) as well as the most important indications are presented. Because CEUS relies on a well performed B-mode Sonography CEUS can not be regarded as a stand-alone technique. Therefor and because most oft the underlying physic of CEUS and B-mode Sonography are similar, a short excursion on the technique of B-mode Sonography is given as well.

Kernaussagen

  • Die kontrastverstärkte Sonografie (CEUS) oder die sog. signalverstärkte Sonografie ist eine mittlerweile bei vielen Fragestellungen etablierte und wichtige Ergänzung zur B-Bild-Sonografie.

  • Basis der CEUS sind neben einem entsprechend dazu geeigneten Sonografiegerät als Kontrastmittel gasgefüllte Kügelchen mit einer extrem dünnen Hülle aus Eiweißen und Lipiden.

  • Bei einem Schalldruck zwischen 100 und 500 kPa (MI 0,1 – 0,5) ist die Dilatation der Mikrobläschen größer als die Kompression. Dies führt zu einer Asymmetrie des Echos und der Entstehung nicht linearer (harmonischer) Schwingungen.

  • Kontrastspezifische Ultraschallverfahren basieren auf einer Auslöschung des vom Gewebe verursachten linearen Ultraschallsignals und der Verwendung der nicht linearen Antwort der Mikrobläschen.

  • Wo Mikrobläschen im Ultraschall zu sehen sind, wird die entsprechende Struktur (normales Organ oder auch ein Tumor) durchblutet. Falls keine Mikrobläschen zu sehen sind, handelt es sich um eine Struktur ohne Gefäße, z. B. eine Zyste, ein frisches Hämatom, einen nekrotischen Tumor oder einen Infarkt.

  • Ultraschallkontrastmittel dienen nicht der Verbesserung technisch unzureichender B-Bild-Untersuchungen, da hier wie dort die gleichen Einschränkungen gelten (z. B. Adipositas und Darmgasüberlagerung).

  • Signalverstärkte Untersuchungen ermöglichen Zusatzinformationen (Durchblutung, Kontrastmittelkinetik), die ohne Kontrastmittel nicht verfügbar wären.

  • Mittels CEUS gelingt es, frische Verletzungen parenchymatöser Organe darzustellen.

  • Mittels CEUS gelingt die Differenzierung zwischen benignen und malignen Leberherden mit einer sehr hohen Genauigkeit, da sich in der Spätphase so gut wie alle malignen Läsionen echoarm darstellen, die Mehrzahl der soliden benignen Läsionen dagegen isoechogen oder echoreich. Ausnahmen dieser Regel bestehen insbesondere beim Leberzelladenom sowie beim atypischen HCC.

  • Mittels kontrastverstärkter Sonografie können signifikant mehr Lebermetastasen erkannt werden als mittels konventioneller B-Bild-Sonografie.

Schlüsselwörter

kontrastverstärkte Sonografie - CEUS - signalverstärkte Sonografie - Ultraschalltechnik - harmonische Bildgebung

Key words

contrast enhanced ultrasound - harmonic imaging
 

  • Literatur

  • 1 Chivers RC, Parry RJ. Ultrasonic velocity and attenuation in mammalian tissues. J Acoust Soc Am 1978; 63: 940-953
    CrossrefPubMedGoogle Scholar
  • 2 Goss SA, Johnston RL, Dunn F. Comprehensive compilation of empirical ultrasonic properties of mammalian tissues. J Acoust Soc Am 1978; 64: 423-457
    CrossrefPubMedGoogle Scholar
  • 3 Stiskal M, Steinbach R, Obholzer G. et al. [Tissue harmonic imaging sonography. Is the image quality in routine abdominal ultrasound improved?]. Rofo 2000; 172: 1006-1010
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Greis C. Summary of technical principles of contrast sonography and future perspectives. Radiologe 2011; 51: 456-461
    CrossrefPubMedGoogle Scholar
  • 5 Albrecht T, Hohmann J. Ultrasound contrast agents. Radiologe 2003; 43: 793-804
    CrossrefPubMedGoogle Scholar
  • 6 Greis C. Technology overview: SonoVue (Bracco, Milan). Eur Radiol 2004; 14 (Suppl. 08) P11-P15
    CrossrefPubMedGoogle Scholar
  • 7 Clevert DA, Weckbach S, Minaifar N. et al. Contrast-enhanced ultrasound versus MS-CT in blunt abdominal trauma. Clin Hemorheol Microcirc 2008; 39: 155-169
    PubMedGoogle Scholar
  • 8 Catalano O, Aiani L, Barozzi L. et al. CEUS in abdominal trauma: multi-center study. Abdom Imaging 2009; 34: 225-234
    CrossrefPubMedGoogle Scholar
  • 9 Claudon M, Dietrich CF, Choi BI. et al. 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 2013; 34: 11-29
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 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 Med 2018; 39: e2-e44 doi:10.1055/a-0586-1107
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Sidhu PS, Cantisani V, Deganello A. et al. Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement. Ultraschall Med 2017; 38: 33-43
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Cosgrove D, Harvey C. Clinical uses of microbubbles in diagnosis and treatment. Med Biol Eng Comput 2009; 47: 813-826
    CrossrefPubMedGoogle Scholar
  • 13 Mork H, Ignee A, Schuessler G. et al. Analysis of neuroendocrine tumour metastases in the liver using contrast enhanced ultrasonography. Scand J Gastroenterol 2007; 42: 652-662
    CrossrefPubMedGoogle Scholar
  • 14 Bernatik T, Seitz K, Blank W. et al. Unclear focal liver lesions in contrast-enhanced ultrasonography-lessons to be learned from the DEGUM multicenter study for the characterization of liver tumors. Ultraschall Med 2010; 31: 577-581
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Seitz K, Bernatik T, Strobel D. et al. Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions in clinical practice (DEGUM Multicenter Trial): CEUS vs. MRI-a prospective comparison in 269 patients. Ultraschall Med 2010; 31: 492-499
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Seitz K, Greis C, Schuler A. et al. Frequency of tumor entities among liver tumors of unclear etiology initially detected by sonography in the noncirrhotic or cirrhotic livers of 1349 patients. Results of the DEGUM multicenter study. Ultraschall Med 2011; 32: 598-603
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Strobel D, Seitz K, Blank W. et al. Contrast-enhanced ultrasound for the characterization of focal liver lesions-diagnostic accuracy in clinical practice (DEGUM multicenter trial). Ultraschall Med 2008; 29: 499-505
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Trillaud H, Bruel JM, Valette PJ. et al. Characterization of focal liver lesions with SonoVue-enhanced sonography: international multicenter-study in comparison to CT and MRI. World J Gastroenterol 2009; 15: 3748-3756
    CrossrefPubMedGoogle Scholar
  • 19 Wilson SR, Burns PN. An algorithm for the diagnosis of focal liver masses using microbubble contrast-enhanced pulse-inversion sonography. AJR Am J Roentgenol 2006; 186: 1401-1412
    CrossrefPubMedGoogle Scholar
  • 20 Beyer LP, Wassermann F, Pregler B. et al. Characterization of Focal Liver Lesions using CEUS and MRI with Liver-Specific Contrast Media: Experience of a Single Radiologic Center. Ultraschall Med 2017; 38: 619-625
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Dietrich CF, Mertens JC, Braden B. et al. Contrast-enhanced ultrasound of histologically proven liver hemangiomas. Hepatology 2007; 45: 1139-1145
    CrossrefPubMedGoogle Scholar
  • 22 Dietrich CF, Schuessler G, Trojan J. et al. Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Br J Radiol 2005; 78: 704-707
    CrossrefPubMedGoogle Scholar
  • 23 Piscaglia F, Lencioni R, Sagrini E. et al. Characterization of focal liver lesions with contrast-enhanced ultrasound. Ultrasound Med Biol 2010; 36: 531-550
    CrossrefPubMedGoogle Scholar
  • 24 Shanbhogue A, Shah SN, Zaheer A. et al. Hepatocellular adenomas: current update on genetics, taxonomy, and management. J Comput Assist Tomogr 2011; 35: 159-166
    CrossrefPubMedGoogle Scholar
  • 25 Hirche TO, Ignee A, Hirche H. et al. Evaluation of hepatic steatosis by ultrasound in patients with chronic hepatitis C virus infection. Liver Int 2007; 27: 748-757
    CrossrefPubMedGoogle Scholar
  • 26 Catalano O, Sandomenico F, Nunziata A. et al. Transient hepatic echogenicity difference on contrast-enhanced ultrasonography: sonographic sign and pitfall. J Ultrasound Med 2007; 26: 337-345
    CrossrefPubMedGoogle Scholar
  • 27 Catalano O, Sandomenico F, Raso MM, Siani A. Low mechanical index contrast-enhanced sonographic findings of pyogenic hepatic abscesses. AJR Am J Roentgenol 2004; 182: 447-450
    CrossrefPubMedGoogle Scholar
  • 28 Liu GJ, Lu MD, Xie XY. et al. Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions. J Ultrasound Med 2008; 27: 657-666
    CrossrefPubMedGoogle Scholar
  • 29 Cao BS, Li XL, Li N. et al. The nodular form of hepatic tuberculosis: contrast-enhanced ultrasonographic findings with pathologic correlation. J Ultrasound Med 2010; 29: 881-888
    CrossrefPubMedGoogle Scholar
  • 30 Wang Z, Xu HX, Xie XY. et al. Imaging features of hepatic angiomyolipomas on real-time contrast-enhanced ultrasound. Br J Radiol 2010; 83: 411-418
    CrossrefPubMedGoogle Scholar
  • 31 Ignee A, Piscaglia F, Ott M. et al. A benign tumour of the liver mimicking malignant liver disease-cholangiocellular adenoma. Scand J Gastroenterol 2009; 44: 633-636
    CrossrefPubMedGoogle Scholar
  • 32 Mandry D, Bressenot A, Galloy MA. et al. Contrast-enhanced ultrasound in fibro-lamellar hepatocellular carcinoma: a case report. Ultraschall Med 2007; 28: 547-552
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Chen LD, Xu HX, Xie XY. et al. Enhancement patterns of intrahepatic cholangiocarcinoma: comparison between contrast-enhanced ultrasound and contrast-enhanced CT. Br J Radiol 2008; 81: 881-889
    CrossrefPubMedGoogle Scholar
  • 34 Chen LD, Xu HX, Xie XY. et al. Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound. Eur Radiol 2010; 20: 743-753
    CrossrefPubMedGoogle Scholar
  • 35 Xu HX, Lu MD, Liu GJ. et al. Imaging of peripheral cholangiocarcinoma with low-mechanical index contrast-enhanced sonography and SonoVue: initial experience. J Ultrasound Med 2006; 25: 23-33
    CrossrefPubMedGoogle Scholar
  • 36 Dietrich CF, Kratzer W, Strobe D. et al. Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI. World J Gastroenterol 2006; 12: 1699-1705
    CrossrefPubMedGoogle Scholar
  • 37 Dietrich CF, Braden B, Hocke M. et al. Improved characterisation of solitary solid pancreatic tumours using contrast enhanced transabdominal ultrasound. J Cancer Res Clin Oncol 2008; 134: 635-643
    CrossrefPubMedGoogle Scholar
  • 38 Ding H, Wang WP, Huang BJ. et al. Imaging of focal liver lesions: low-mechanical-index real-time ultrasonography with SonoVue. J Ultrasound Med 2005; 24: 285-297
    CrossrefPubMedGoogle Scholar
  • 39 Schuessler G, Fellbaum C, Fauth F. et al. The infammatory pseudotumour – an unusual liver tumour. Ultraschall Med 2006; 27: 273-279
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Foschi FG, DallʼAglio AC, Marano G. et al. Role of contrast-enhanced ultrasonography in primary hepatic lymphoma. J Ultrasound Med 2010; 29: 1353-1356
    CrossrefPubMedGoogle Scholar
  • 41 Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53: 1020-1022
    CrossrefPubMedGoogle Scholar
  • 42 Forner A, Vilana R, Ayuso C. et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008; 47: 97-104
    CrossrefPubMedGoogle Scholar
  • 43 Iavarone M, Sangiovanni A, Forzenigo LV. et al. Diagnosis of hepatocellular carcinoma in cirrhosis by dynamic contrast imaging: the importance of tumor cell differentiation. Hepatology 2010; 52: 1723-1730
    CrossrefPubMedGoogle Scholar
  • 44 Bolondi L, Gaiani S, Celli N. et al. Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 2005; 42: 27-34
    CrossrefPubMedGoogle Scholar
  • 45 Matsui O. Detection and characterization of hepatocellular carcinoma by imaging. Clin Gastroenterol Hepatol 2005; 3: S136-S140
    CrossrefPubMedGoogle Scholar
  • 46 Boozari B, Soudah B, Rifai K. et al. Grading of hypervascular hepatocellular carcinoma using late phase of contrast enhanced sonography – a prospective study. Dig Liver Dis 2011; 43: 484-490
    CrossrefPubMedGoogle Scholar
  • 47 Fan ZH, Chen MH, Dai Y. et al. Evaluation of primary malignancies of the liver using contrast-enhanced sonography: correlation with pathology. AJR Am J Roentgenol 2006; 186: 1512-1519
    CrossrefPubMedGoogle Scholar
  • 48 Jang HJ, Kim TK, Burns PN, Wilson SR. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology 2007; 244: 898-906
    CrossrefPubMedGoogle Scholar
  • 49 Ferrara N, Kerbel RS. Angiogenesis as a therapeutic target. Nature 2005; 438: 967-974
    CrossrefPubMedGoogle Scholar
  • 50 Leoni S, Piscaglia F, Golfieri R. et al. The impact of vascular and nonvascular findings on the noninvasive diagnosis of small hepatocellular carcinoma based on the EASL and AASLD criteria. Am J Gastroenterol 2010; 105: 599-609
    CrossrefPubMedGoogle Scholar
  • 51 Manini MA, Sangiovanni A, Fornari F. et al. Clinical and economical impact of 2010 AASLD guidelines for the diagnosis of hepatocellular carcinoma. J Hepatol 2014; 60: 995-1001
    CrossrefPubMedGoogle Scholar
  • 52 Sangiovanni A, Manini MA, Iavarone M. et al. The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 2010; 59: 638-644
    CrossrefPubMedGoogle Scholar
  • 53 Chen MH, Dai Y, Yan K. et al. The role of contrast-enhanced ultrasound on the diagnosis of small hepatocellular carcinoma (</=3 cm) in patients with cirrhosis. Hepatol Res 2006; 35: 281-288
    CrossrefPubMedGoogle Scholar
  • 54 Strobel D, Kleinecke C, Hansler J. et al. Contrast-enhanced sonography for the characterisation of hepatocellular carcinomas-correlation with histological differentiation. Ultraschall Med 2005; 26: 270-276
    Article in Thieme ConnectPubMedGoogle Scholar
  • 55 Cantisani V, Ricci P, Erturk M. et al. Detection of hepatic metastases from colorectal cancer: prospective evaluation of gray scale US versus SonoVue(R) low mechanical index real time-enhanced US as compared with multidetector-CT or Gd-BOPTA-MRI. Ultraschall Med 2010; 31: 500-505
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Chami L, Lassau N, Malka D. et al. Benefits of contrast-enhanced sonography for the detection of liver lesions: comparison with histologic findings. AJR Am J Roentgenol 2008; 190: 683-690
    CrossrefPubMedGoogle Scholar
  • 57 Inoue T, Kudo M, Hatanaka K. et al. Usefulness of contrast-enhanced ultrasonography to evaluate the post-treatment responses of radiofrequency ablation for hepatocellular carcinoma: comparison with dynamic CT. Oncology 2013; 84 (Suppl. 01) 51-57
    CrossrefPubMedGoogle Scholar
  • 58 Konopke R, Kersting S, Bergert H. et al. Contrast-enhanced ultrasonography to detect liver metastases: a prospective trial to compare transcutaneous unenhanced and contrast-enhanced ultrasonography in patients undergoing laparotomy. Int J Colorectal Dis 2007; 22: 201-207
    CrossrefPubMedGoogle Scholar
  • 59 Larsen LP, Rosenkilde M, Christensen H. et al. The value of contrast enhanced ultrasonography in detection of liver metastases from colorectal cancer: a prospective double-blinded study. Eur J Radiol 2007; 62: 302-307
    CrossrefPubMedGoogle Scholar
  • 60 Larsen LP, Rosenkilde M, Christensen H. et al. Can contrast-enhanced ultrasonography replace multidetector-computed tomography in the detection of liver metastases from colorectal cancer?. Eur J Radiol 2009; 69: 308-313
    CrossrefPubMedGoogle Scholar
  • 61 Piscaglia F, Corradi F, Mancini M. et al. Real time contrast enhanced ultrasonography in detection of liver metastases from gastrointestinal cancer. BMC Cancer 2007; 7: 171
    CrossrefPubMedGoogle Scholar
  • 62 Quaia E, DʼOnofrio M, Palumbo A. et al. Comparison of contrast-enhanced ultrasonography versus baseline ultrasound and contrast-enhanced computed tomography in metastatic disease of the liver: diagnostic performance and confidence. Eur Radiol 2006; 16: 1599-1609
    CrossrefPubMedGoogle Scholar
  • 63 Konopke R, Bunk A, Kersting S. Contrast-enhanced ultrasonography in patients with colorectal liver metastases after chemotherapy. Ultraschall Med 2008; 29 (Suppl. 04) S203-S209
    Article in Thieme ConnectPubMedGoogle Scholar
  • 64 Fioole B, de Haas RJ, Wicherts DA. et al. Additional value of contrast enhanced intraoperative ultrasound for colorectal liver metastases. Eur J Radiol 2008; 67: 169-176
    CrossrefPubMedGoogle Scholar
  • 65 Leen E, Moug SJ, Horgan P. Potential impact and utilization of ultrasound contrast media. Eur Radiol 2004; 14 (Suppl. 08) P16-P24
    CrossrefPubMedGoogle Scholar
  • 66 Nakano H, Ishida Y, Hatakeyama T. et al. Contrast-enhanced intraoperative ultrasonography equipped with late Kupffer-phase image obtained by sonazoid in patients with colorectal liver metastases. World J Gastroenterol 2008; 14: 3207-3211
    CrossrefPubMedGoogle Scholar
  • 67 Lu Q, Luo Y, Yuan CX. et al. Value of contrast-enhanced intraoperative ultrasound for cirrhotic patients with hepatocellular carcinoma: a report of 20 cases. World J Gastroenterol 2008; 14: 4005-4010
    CrossrefPubMedGoogle Scholar
  • 68 Torzilli G, Del Fabbro D, Palmisano A. et al. Contrast-enhanced intraoperative ultrasonography during hepatectomies for colorectal cancer liver metastases. J Gastrointest Surg 2005; 9: 1148-1153 discussion 1153
    CrossrefPubMedGoogle Scholar
  • 69 Torzilli G, Del Fabbro D, Palmisano A. et al. Contrast-enhanced intraoperative ultrasonography: a valuable and not any more monocentric diagnostic technique performed in different ways.[letter]. Ann Surg 2007; 245: 152-153 author reply 152
    CrossrefPubMedGoogle Scholar
  • 70 Piscaglia F, Gianstefani A, Ravaioli M. et al. Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transpl 2010; 16: 658-667
    CrossrefPubMedGoogle Scholar
  • 71 Rossi S, Ghittoni G, Ravetta V. et al. Contrast-enhanced ultrasonography and spiral computed tomography in the detection and characterization of portal vein thrombosis complicating hepatocellular carcinoma. Eur Radiol 2008; 18: 1749-1756
    CrossrefPubMedGoogle Scholar
  • 72 Sorrentino P, DʼAngelo S, Tarantino L. et al. Contrast-enhanced sonography versus biopsy for the differential diagnosis of thrombosis in hepatocellular carcinoma patients. World J Gastroenterol 2009; 15: 2245-2251
    CrossrefPubMedGoogle Scholar
  • 73 Choi D, Lim HK, Lee WJ. et al. Early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma: utility of gray scale harmonic ultrasonography with a microbubble contrast agent. J Ultrasound Med 2003; 22: 1163-1172
    CrossrefPubMedGoogle Scholar
  • 74 Minami Y, Kudo M, Chung H. et al. Contrast harmonic sonography-guided radiofrequency ablation therapy versus B-mode sonography in hepatocellular carcinoma: prospective randomized controlled trial. AJR Am J Roentgenol 2007; 188: 489-494
    CrossrefPubMedGoogle Scholar
  • 75 Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30: 52-60
    Article in Thieme ConnectPubMedGoogle Scholar
  • 76 Shiozawa K, Watanabe M, Takayama R. et al. Evaluation of local recurrence after treatment for hepatocellular carcinoma by contrast-enhanced ultrasonography using Sonazoid: comparison with dynamic computed tomography. J Clin Ultrasound 2010; 38: 182-189
    PubMedGoogle Scholar
  • 77 Berstad AE, Brabrand K, Foss A. Clinical utility of microbubble contrast-enhanced ultrasound in the diagnosis of hepatic artery occlusion after liver transplantation. Transpl Int 2009; 22: 954-960
    CrossrefPubMedGoogle Scholar
  • 78 Clevert DA, Stickel M, Minaifar N. et al. Contrast-enhanced ultrasound in liver transplant: first results and potential for complications in the postoperative period. Clin Hemorheol Microcirc 2009; 43: 83-94
    PubMedGoogle Scholar
  • 79 Lu Q, Zhong XF, Huang ZX. et al. Role of contrast-enhanced ultrasound in decision support for diagnosis and treatment of hepatic artery thrombosis after liver transplantation. Eur J Radiol 2012; 81: e338-e343
    CrossrefPubMedGoogle Scholar
  • 80 Sidhu PS, Shaw AS, Ellis SM. et al. Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography. Eur Radiol 2004; 14: 21-30
    CrossrefPubMedGoogle Scholar
  • 81 Zheng RQ, Mao R, Ren J. et al. Contrast-enhanced ultrasound for the evaluation of hepatic artery stenosis after liver transplantation: potential role in changing the clinical algorithm. Liver Transpl 2010; 16: 729-735
    CrossrefPubMedGoogle Scholar
  • 82 Darge K. Voiding urosonography: an additional important indication for use of US contrast agents.[letter]. Radiology 2011; 259: 614-615 author reply 615
    CrossrefPubMedGoogle Scholar
  • 83 Mazziotti S, Zimbaro F, Pandolfo A. et al. Usefulness of contrast-enhanced ultrasonography in the diagnosis of renal pseudotumors. Abdom Imaging 2010; 35: 241-245
    CrossrefPubMedGoogle Scholar
  • 84 Clevert DA, Minaifar N, Weckbach S. et al. Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 2008; 39: 171-178
    PubMedGoogle Scholar
  • 85 Park BK, Kim B, Kim SH. et al. Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol 2007; 61: 310-314
    CrossrefPubMedGoogle Scholar
  • 86 DʼOnofrio M, Malago R, Zamboni G. et al. Contrast-enhanced ultrasonography better identifies pancreatic tumor vascularization than helical CT. Pancreatology 2005; 5: 398-402
    CrossrefPubMedGoogle Scholar
  • 87 DʼOnofrio M, Barbi E, Dietrich CF. et al. Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol 2012; 81: 630-638
    CrossrefPubMedGoogle Scholar
  • 88 Dong Y, DʼOnofrio M, Hocke M. et al. Autoimmune pancreatitis: Imaging features. Endosc Ultrasound 2017; DOI: 10.4103/eus.eus_23_17.
    CrossrefPubMedGoogle Scholar
  • 89 Neesse A, Huth J, Kunsch S. et al. Contrast-enhanced ultrasound pattern of splenic metastases – a retrospective study in 32 patients. Ultraschall Med 2010; 31: 264-269
    Article in Thieme ConnectPubMedGoogle Scholar
  • 90 Gorg C, Faoro C, Bert T. et al. Contrast enhanced ultrasound of splenic lymphoma involvement. Eur J Radiol 2011; 80: 169-174
    CrossrefPubMedGoogle Scholar
  • 91 Yu X, Yu J, Liang P, Liu F. Real-time contrast-enhanced ultrasound in diagnosing of focal spleen lesions. Eur J Radiol 2012; 81: 430-436
    CrossrefPubMedGoogle Scholar
  • 92 Bertolotto M, Quaia E, Zappetti R. et al. Differential diagnosis between splenic nodules and peritoneal metastases with contrast-enhanced ultrasound based on signal-intensity characteristics during the late phase. Radiol Med 2009; 114: 42-51
    CrossrefPubMedGoogle Scholar
  • 93 Girlich C, Schacherer D, Jung EM. et al. Comparison between a clinical activity index (Harvey-Bradshaw-Index), laboratory inflammation markers and quantitative assessment of bowel wall vascularization by contrast-enhanced ultrasound in Crohnʼs disease. Eur J Radiol 2012; 81: 1105-1109
    CrossrefPubMedGoogle Scholar
  • 94 David E, Cantisani V, Grazhdani H. et al. What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale. J Ultrasound 2016; 19: 281-287
    CrossrefPubMedGoogle Scholar