Contrast-enhanced ultrasound (CEUS) may be in for a big 2026 thanks to growing interest and a recent measure implemented by the U.S. Centers for Medicare and Medicaid Services (CMS).
In this first episode of the Ultrasound MinnieCast, Richard Barr, MD, discusses current and potential applications for CEUS. This includes a growing interest in the modality as research continues to show its high safety profile and ability to detect and characterize abnormal findings. He also outlines CEUS' advantages over other imaging modalities and the use of microbubbles instead of iodine- or gadolinium-based contrast agents.
Barr is a radiologist at Northeast Ohio Medical University in Rootstown and serves as an officer for the International Contrast Ultrasound Society (ICUS).
Barr also talks about how practices could benefit from a cost standpoint, with the CMS in December announcing that it will double reimbursement for certain noncardiac CEUS exams, effective January 1. With this, reimbursement has risen from $170.02 to $358.35.
Finally, Barr shares ICUS' goals for 2026, including paving the way for whole-body imaging with CEUS.
![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)
