Niche intravascular applications of contrast-enhanced ultrasound: Pushing the Envelope!

Contrast-enhanced ultrasound (CEUS) has gained widespread acceptance in recent years. The addition of ultrasound contrast overcomes the primary limitation of conventional sonography by providing real-time visualization of perfusion characteristics within the target structure. Various publications have described the utility of CEUS in characterising visceral focal lesions. However, in practice, CEUS is used more as a problem-solving modality to obviate the need for CT / MRI or where the latter are indeterminate. We aim to highlight the niche indications where intravascular CEUS may be preferred as the investigation of choice, based on its ease of use and the likelihood of resolving the clinical dilemma. The article is organized with a brief description of the basic principle and advantages of CEUS, followed by an illustration of the specific niche applications. Routine indications like evaluation of focal liver lesions in cirrhosis, demonstrating typical enhancement patterns in hemangioma and focal nodular hyperplasia, and differentiating neuroendocrine tumors from hypovascular tumors (like pancreatic ductal carcinoma) are beyond the purview of this article.