(Radiology Review) Contrast-enhanced ultrasound (CEUS) can effectively evaluate blunt hepatic trauma, and has superior sensitivity compared to sonography without contrast enhancement, according to Italian radiologists. Dr. Orlando Catalano and colleagues at Istituto G. Pascale in Naples recommended that CEUS be used as the initial imaging modality when screening patients after blunt abdominal trauma.
Published in the Journal of Ultrasound in Medicine, their research also determined that CEUS should be used to check patient progress in trauma patients being conservatively managed.
During a three-year period, a total of 431 patients had ultrasound imaging following blunt abdominal trauma, and 87 of these required further evaluations with contrast-enhanced sonography and CT. "Indications for further assessment were baseline sonographic findings positive for liver injury, baseline sonographic findings positive for injury to other abdominal parenchyma, baseline sonographic findings positive for free fluid only, baseline sonographic findings indeterminate, and baseline sonographic findings negative with persistent clinical or laboratory suspicion," they stated.
The imaging criteria compared were injury conspicuity and size, completeness of injury extension, and involvement of the liver capsule.
SonoVue (Bracco, Milan, Italy), a second-generation contrast agent consisting of perfluorochemical microbubbles stabilized by a phospholipidic membrane, was administered through the antecubital vein using a 20-gauge catheter with a three-way stopcock. A dose of 4.8 mL or 2.4 mL was given as a single quick bolus followed by 5-10 mL of normal saline. Low mechanical-index power levels were selected, and harmonic imaging and a contrast-specific technology also were used to improve image quality and bubble visibility.
CT showed 23 hepatic lesions in 21 patients, and 19 of these patients had peritoneal or retroperitoneal fluid shown on all three modalities. Ultrasound imaging demonstrated liver injury in 15 patients, and CEUS showed injury in 19 patients. CEUS did not improve image quality (penetration) in large, technically difficult patients in whom the posterior liver was not visible, they stated.
"Our data show that (CEUS) is a promising tool in the initial assessment and follow-up of blunt liver trauma. It allows more accurate assessment of liver lesions in comparison with baseline sonography. It is also more accurate and informative than conventional sonography, and correlates better with CT findings," the researchers concluded. Using CEUS would also result reduced examination cost, radiation exposure, and use of ionic contrast media, according to Dr. Catalano.
"Blunt Hepatic Trauma: Evaluation With Contrast-Enhanced Sonography: Sonographic Findings and Clinical Application"
Catalano, Orlando; et al
Department of Radiology, Istituto G. Pascale, Via F. Crispi 92, I-80121 Naples, Italy
J Ultrasound Med 2005 (March); 24: 299-310
By Radiology Review
March 21, 2005
Copyright © 2005 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
