Role of CEUS in Vascular Pathology

Vito Cantisani; Nicola Di Leo; Emanuele David; Dirk-André Clevert

doi:10.1055/a-1403-2400

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2021; 42(04): 348-366
DOI: 10.1055/a-1403-2400

Continuing Medical Education

Role of CEUS in Vascular Pathology

Stellenwert von CEUS in der Gefäßpathologie

Vito Cantisani

¹Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, „Sapienza“ University of Rome, Rome, Italy, Universita degli Studi di Roma La Sapienza, Roma, Italy

,

Nicola Di Leo

¹Department of Radiological, Oncological and Anatomopathological Sciences-Radiology, „Sapienza“ University of Rome, Rome, Italy, Universita degli Studi di Roma La Sapienza, Roma, Italy

,

Emanuele David

²Radiological Sciences, Radiology Unit, Papardo-Hospital, Messina, Italy, Messina, Italy.

,

Dirk-André Clevert

³Department of Clinical Radiology, University of Munich-Großhadern Campus, Munich, Germany

› Author Affiliations

Abstract

In recent years, the implementation of contrast-enhanced ultrasound (CEUS) in clinical practice has opened new horizons in the arterial pathologies research field, since this technique is able to supply new sets of data that can be crucial in patient management. The main applications of CEUS in the arterial system are the detection, characterization, and follow-up of carotid plaques and endoleaks after EVAR. Other situations in which CEUS was demonstrated to be a useful tool are large vessel vasculitis, dissections, and untreated aneurysms. In carotid atherosclerosis CEUS is not only able to acquire quantitative data about stenosis but also to perform a qualitative assessment of the plaque. The most important plaque features that CEUS is able to depict are ulceration, neovascularization, and the presence of inflammatory infiltrates. All of these factors contribute to plaque vulnerability. Thus, CEUS is crucial in order to allow better risk stratification and management of patients. In follow-up after EVAR, CEUS shows sensitivity and specificity values similar to CTA while ensuring several advantages, such as lower cost and the absence of ionizing radiation and nephrotoxic agents. Moreover, CEUS is able to offer real-time evaluation of endoleaks and thus is a useful tool in cases that are ambiguous on CTA. Most limitations are patient-related and are the same as in all other ultrasound techniques, such as high BMI and meteorism.

Zusammenfassung

In den letzten Jahren hat der Einsatz des kontrastverstärkten Ultraschalls (CEUS) in der klinischen Praxis neue Horizonte auf dem Forschungsgebiet der arteriellen Pathologien eröffnet, da diese Technik neue Datensätze liefern kann, die von entscheidender Bedeutung für das Patientenmanagement sein können.

Die Hauptanwendungen von CEUS beim arteriellen System sind Nachweis, Charakterisierung und Verlaufskontrolle von Karotisplaques sowie von Endoleaks nach EVAR. Andere Fälle, in denen sich CEUS als nützliches Instrument erwiesen hat, betreffen die Vaskulitiden großer Gefäße, Dissektionen und nicht behandelte Aneurysmen.

Bei Arteriosklerose der A. carotis kann CEUS nicht nur quantitative Daten zur Stenose erfassen, sondern auch eine qualitative Beurteilung der Plaque durchführen. Die wichtigsten Plaque-Merkmale, die CEUS darstellen kann, sind Ulzeration, Neovaskularisation und das Vorhandensein von entzündlichen Infiltraten. Alle diese Faktoren tragen zur Vulnerabilität der Plaque bei. Daher ist CEUS von entscheidender Bedeutung, um die Risikostratifizierung und das Management der Patienten zu verbessern.

In der Nachsorge nach EVAR zeigt CEUS ähnliche Sensitivitäts- und Spezifitätswerte wie die CTA und bietet gleichzeitig mehrere Vorteile, wie z. B. geringere Kosten sowie Verzicht auf Strahlenbelastung und auf nephrotoxische Substanzen. Darüber hinaus ermöglicht CEUS die Echtzeit-Evaluierung von Endoleaks, ein wertvolles Instrument für Fälle, in denen die CTA nicht eindeutig ist. Die meisten Einschränkungen sind patientenbezogen und bei allen anderen Ultraschalltechniken gleich, wie z. B. ein hoher BMI und Meteorismus.

Full Text

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