Contrast-enhanced ultrasound (CEUS) is underutilized in the U.S., which may lead to greater risk for patients than side effects tied to contrast media use, said doctors who spoke at the 37th International Bubble Conference in Chicago.
The conference attracted CEUS experts from North America, Europe, China, and Brazil. It focused on advances in the use of microbubble ultrasound enhancing agents used routinely to diagnose heart and vascular disease, identify and characterize tumors, monitor chronic gastro-intestinal diseases, evaluate other serious medical conditions, and monitor therapy.
The experts who spoke at the conference highlighting CEUS' potential included Jordan Strom, MD, from Harvard Medical School, and Tom Porter, MD, from the University of Nebraska Medical Center in Omaha and lead author of the International Contrast Ultrasound Society (ICUS) guidelines, according to ICUS.
Strom and Porter said that CEUS is safe and that dilution of the contrast imaging agent is key. They added that these agents present a rare risk of a severe allergic reaction in one out of 15,000 patients, compared with the risk of life-threatening actions in one out of 500 to one out of 5,000 patients from the iodinated contrast agents used for CT, they added.
Additionally, underuse of CEUS could lead to greater risk to patient health, the experts said. They highlighted that CEUS produces vital diagnostic information and in studies has been tied to reduced need for downstream imaging and cardiac catheterizations. They also reported that CEUS use has been linked to a reduced length of hospital stay in some patients.
![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)
