Contrast-enhanced ultrasound (CEUS) could be a suitable alternative to CT for early detection of complications in splenic trauma that’s nonoperatively managed, according to a study presented on February 28 at ECR 2025.
In his talk, Niccolò Finardi from the University of Milan in Italy presented his team’s research, demonstrating CEUS’ high diagnostic accuracy at different time points after spleen trauma occurs, ranging from within 48 hours to 60 days’ follow-up.
“Our study findings indicate that CEUS could be a valuable tool in clinical practice for the follow-up of post-traumatic spleen injuries treated with angioembolization, contributing to a safer and more effective approach in patient management,” Finardi said.
Niccolò Finardi presents his team's research at ECR 2025, showing how CEUS may be a suitable, radiation-free alternative to CT for managing spleen trauma in emergency settings.
The spleen is one of the most often injured organs in blunt abdominal trauma cases. Focused Assessment with Sonography in Trauma (FAST) and contrast-enhanced CT are two go-to methods for finding parenchymal or vascular spleen lesions.
However, Finardi noted that there has been a movement in recent years to manage trauma non-operatively. CEUS is a radiation-free method that can detect lesions within minutes using microbubble agents. Finardi said this offers a fast and safe method for monitoring damage.
CEUS can be used for follow-up of conservatively managed trauma to reduce the number of CT exams, especially in children, according to guidelines published in 2017 by the European Federation Society of Ultrasound in Medicine and Biology (EFSUMB). Finardi, however, highlighted that timing for such management has not been established.
The Finardi team developed a CEUS protocol to monitor spleen trauma cases that are managed nonoperatively.
They tested the protocol in a prospective study of 28 patients who presented to the emergency department with abdominal trauma and were diagnosed with parenchymal or vascular spleen injuries. One patient dropped out of the study due to the critical nature of their injury.
Initial assessments included contrast-enhanced CT and follow-up evaluations using CEUS at different time points to monitor lesion progression and healing patterns. These included the following: 48 hours, 12 to 15 days, 30 days, and 60 days post-trauma to monitor lesion progression and healing.
Among the patients, 25 underwent embolization. CEUS at 48 hours showed splenic infarcts in 10 of these patients. In 24 patients, the researchers observed increased free fluid, vascular lesions, or hematoma progression cases.
One patient within 48 hours of a CEUS exam experienced cardio-respiratory arrest after experiencing a severe allergic reaction to the contrast, requiring intervention.
“This highlights the importance of being prepared to treat this complication, which is rare but can occur sometimes,” Finardi said.
Finardi said that CEUS has its share of advantages over CT other than being radiation-free. These include using a non-nephrotoxic contrast medium, the ability to be performed at the bedside, and anaphylactoid reactions being rare.
Read AuntMinnieEurope.com's entire coverage of ECR 2025 on our RADCast.
![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)
