Pitfalls and artefacts using contrast enhanced ultrasound

Area of Science:

• Medical Imaging
• Diagnostic Ultrasound
• Contrast-Enhanced Ultrasound (CEUS)

Background:

• Ultrasound is a primary imaging modality for detecting and characterizing various organic diseases.
• Contrast enhanced ultrasound (CEUS) is increasingly utilized for hepatic, renal, and pancreatic indications due to growing evidence and a favorable safety profile.
• CEUS offers a low rate of adverse events compared to iodinated contrast agents, making it suitable for patients with renal insufficiency or thyroid autonomy.

Purpose of the Study:

• To present common pitfalls and technical considerations in contrast enhanced ultrasound (CEUS).
• To provide a foundation for investigators to avoid misinterpretations of CEUS images, especially concerning artifacts.
• To highlight key technical aspects crucial for the accurate application of CEUS in clinical practice.

Main Methods:

• Review and illustration of specific CEUS-related artifacts and technical challenges.
• Discussion of factors influencing microbubble destruction, such as acoustic power (mechanical index).
• Analysis of image quality factors including frame rate, focus positioning, and contrast agent dosage.

Main Results:

• Identified pitfalls include false positive signals in non-vascularized areas and signal attenuation from excessive contrast dosage.
• Demonstrated the impact of acoustic power on microbubble destruction and frame rate on spatial resolution.
• Evaluated the advantages and disadvantages of replenishment studies and the reliability of contrast-enhanced spectral Doppler measurements.

Conclusions:

• A thorough understanding of CEUS technical aspects is essential for accurate interpretation and to mitigate potential misdiagnosis.
• Awareness of CEUS-specific artifacts and technical parameters is critical for optimal diagnostic performance.
• This article serves as a guide to common CEUS challenges, supported by illustrative examples.