Contrast-Enhanced Ultrasound in Posterior Segment Disease: A Narrative and Pictorial Review

To review the applications of contrast‑enhanced ultrasound (CEUS) in the evaluation of retinal and choroidal disease, and to present a series of illustrative cases highlighting its clinical utility.

A comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Cochrane library, and Google Scholar was conducted in August 2025 to identify studies describing or differentiating CEUS features in retinal and choroidal pathology. Studies were included if CEUS findings were correlated with clinical, multimodal imaging, or histopathological diagnoses. Additionally, we present a prospective case series of posterior segment pathologies utilising B-mode US, colour Doppler ultrasound (CDUS), and CEUS (Definity®) to descriptively analyse imaging characteristics.

In choroidal lesions, CEUS can differentiate hemangioma (slow centripetal homogenous, prolonged late enhancement) from melanoma (rapid peripheral enhancement with early washout) and metastasis (rapid wash-in with variable wash-out). Choroidal detachment shows rapid, homogenous enhancement with clear distinction from non-enhancing subchoroidal haemorrhage. In retinal disease, CEUS improves the sensitivity for retinal detachment detection compared with B-mode/CDUS and provides an imaging option for eyes with media opacity. CEUS can distinguish RD from benign vitreoretinal conditions such as degenerative retinoschisis and posterior vitreous detachment due to the presence of contrast enhancement. Acute RD generally shows significant contrast uptake, whereas chronic RD may show variable findings. In peripheral exudative haemorrhagic chorioretinopathy, CEUS reveals a peripherally enhancing lesion surrounding a central region of hypoenhancing haemorrhagic core.

CEUS enables real-time assessment of the retinal and choroidal microcirculation, improving diagnostic accuracy and radiological characterisation across several posterior segment pathologies. Larger prospective studies are warranted to better define the role of CEUS in clinical practice.