Table 1.

Summary of CEUS applications for various abdominal interventions

Abdominal interventions	Specific strengths of CEUS over conventional US	Specific strengths over enhanced CT or fluoroscopic-guided intervention
Drainage	Ability to differentiate avascular complex abscesses from other vascular masses Improve delineation of abscess boundary and surrounding enhancing parenchyma Improve depiction of the avascular necrotic portion, loculation and internal septation Minimize the risk of inadvertent injury to the adjacent organ Endocavitary CEUS through the drainage catheter facilitates monitoring of the position and patency of catheters within collections Endocavitary CEUS allows visualization of communication between a collection and adjacent structures	Multiplanar imaging which allows approach from different angles Repeatability without risk of iodinated contrast-related nephrotoxicity Portability with potential to be performed at any location Real-time imaging of abnormal communication with adjacent structures with absence of ionizing radiation
Biopsy	Demonstration vascularization to enable differentiation between isoechoic tumor and normal parenchyma Improve biopsy-positive yield by revealing the vascular portion of the target Provide spatial information of necrotic areas to avoid Improves visualization of atrophic parenchyma in renal biopsy for evaluation of nephropathies	Multiplanar imaging which allows approach from different angles Negate need for nephrotoxic contrast medium or ionizing radiation Portability with potential to be performed at any location
Percutaneous nephrostomy insertion	Intravenous CEUS improves the visibility of the non-vascularized renal calices Improve success for puncturing non-dilated systems Endocavitary CEUS can verify correct placement of nephrostomy tube Confirm drainage prior to removal of nephrostomy	No risk of distracting blob of contrast material that interferes with the procedure if initial attempt fails Negate need for ionizing radiation Portability with potential to be performed at any location
Biliary intervention	CEUS cholangiography can confirm biliary drainage catheter is positioned adequately Improve visualization of the biliary system particularly in non-dilated biliary system Capacity to depict complications associated with the trans-hepatic drainage, such as an arterial connection with a percutaneous biliary drainage tube	Negate need for ionizing radiation Improved temporal and spatial resolution in imaging complication such as arterial fistula Portability with potential to be performed at any location including patient’s bedside
Thermal ablation of abdominal tumors	Allow lesions inconspicuous on conventional US to be visualized Allow assessment of ablation zone for residual disease immediately post-ablation to determine if a repeat ablation is required Allow assessment of vascularity of ablation scar in followup period	Allows multiple approach planes Procedure guidance in real-time Repeat assessment of ablation zone vascularity immediately post-ablation and during surveillance without need for ionizing radiation burden or use of nephrotoxic iodinated contrast medium
Gastrointestinal application	Endocavitary CEUS allow assessment for complication such as a leak due to dislodged gastrostomy tube	Negate need for ionizing radiation Portability with potential to be performed at any location including patient’s bedside
Detection of vascular complication	Active hemorrhage and pseudoaneurysm could be positively identified on CEUS	Capability to scan the region of interest continuously, thus excluding the theoretical risk of missing a delayed extravasation Can image pseudoaneurysm and confirm success of embolization while patient is on the operating table Negate need for ionizing radiation or nephrotoxic contrast medium during follow up
Pediatric application	Allow enhanced vascular and endocavitary US examination in pediatric population to aid intervention	Negates the need for ionizing radiation or general anesthesia required for alternative therapeutic approach