Table 2.
Remarks on i.v. contrast-enhanced ultrasound technique according to the organ under examination
| Organ | Remarks on technique |
|---|---|
| Liver | Targeted evaluation of the enhancement pattern of a focal lesion in real time |
| Timing of vascular phases different from adults and varies based on age | |
| Arterial phase may start as quickly as 5 s following the administration of microbubbles | |
| May need to do a “sweep scan” to search for focal lesions or trauma | |
| Transplantation | Knowledge of the surgical technique and the exact type of vascular anastomosis is essential for accurate diagnosis |
| Colour and spectral Doppler imaging is still required to assess clinically significant vascular stenosis | |
| Kidney | Rapid cortical enhancement followed by medullary phase lasting up to 2 min post-injection |
| No evaluation of pelvicalyceal system as microbubbles are not excreted | |
| Spleen | Targeted evaluation of the perfusion pattern of a focal lesion |
| Keep in mind the peculiar enhancement pattern of spleen including inhomogeneous (“zebra-like”) initial phase and long-lasting homogeneous delayed enhancement | |
| May need to do a “sweep scan” to detect focal lesions particularly in trauma | |
| Trauma | Two separate doses of microbubbles administered for liver and right kidney and then spleen and left kidney ± pancreas |
| Examination starting from side of clinical concern | |
| Kidneys should be evaluated first owing to earlier enhancement, in the arterial phase, whereas liver and spleen can be assessed during the portal venous phases | |
| Traumatic lesions appear as well-demarcated hypoechoic (non-enhancing) areas | |
| Careful evaluation of the vasculature will detect any pseudoaneurysms | |
| Bowel | 4 h of fasting required |
| Conventional ultrasonography precedes to detect thickened loops | |
| Lower dose of microbubbles are administered when low-frequency transducers are used | |
| Higher dose of microbubbles are administered when high-frequency transducers are used | |
| Quantification of mural enhancement is valuable | |
| Lung/pleura | Targeted evaluation can be performed using coronal plane, similarly to conventional ultrasonography |