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Contrast-enhanced ultrasound: Gastrointestinal applications outside of the liver

Christoph F Dietrich, MD, MBA
Section Editor
Jonathan B Kruskal, MD, PhD
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Contrast-enhanced ultrasound (CEUS) is a well-established technique for imaging the liver and other organs [1-6]. It is used in most of Europe and Asia, as well as in many other countries worldwide, and guidelines are available [7,8]. The contrast agent used for CEUS of the liver has been approved by the US Food and Drug Administration [9]; however, its use in the United States has been mainly limited to research settings [1,2,10]. CEUS is most often used for imaging the liver, but it has also been used to image other gastrointestinal organs, as well as non-gastrointestinal organs such as the heart, spleen, kidneys, and breast [5]. (See "Contrast echocardiography: Clinical applications" and "Contrast echocardiography: Contrast agents, safety, and imaging technique".)

This topic will review the use of CEUS in the pancreas, hepatobiliary system, and gastrointestinal tract. The use of CEUS for the evaluation of liver lesions is discussed separately. (See "Contrast-enhanced ultrasound for the evaluation of liver lesions".)


Contrast-enhanced ultrasound (CEUS) uses ultrasound contrast agents to improve visualization and characterization of anatomic structures and lesions. Ultrasound contrast agents are 1 to 10 microns in size (equal to or smaller than red blood cells) and permit visualization of both the larger blood vessels and the microvasculature. CEUS permits real-time visualization of contrast-enhancement patterns during the arterial and venous phases, and in the case of the liver, the portal-venous phase [11]. The general principles behind CEUS, as well as advantages of CEUS over conventional B-mode ultrasonography, computed tomography, and magnetic resonance imaging, are discussed in detail elsewhere. (See "Contrast-enhanced ultrasound for the evaluation of liver lesions", section on 'General principles' and "Contrast-enhanced ultrasound for the evaluation of liver lesions", section on 'Advantages of CEUS'.)


Contrast-enhanced ultrasound (CEUS) can be performed using a traditional transcutaneous approach or in combination with endoscopic ultrasound (typically done for the evaluation of pancreatic lesions). Only small amounts of ultrasound contrast agents are required for CEUS. For non-liver indications, a dose of 2.4 mL is often sufficient.

Transcutaneous contrast-enhanced ultrasound — Prior to performing CEUS, a conventional transcutaneous (B-mode) ultrasound examination is performed. The ultrasound contrast agent is then injected and imaging is obtained from the arterial and venous phases. The arterial phase is marked by the first visualization of the contrast agent (typically 10 to 20 seconds after contrast injection). Enhancement increases progressively through the arterial phase. The venous phase starts approximately 30 to 45 seconds after contrast injection and is marked by plateauing of the enhancement followed by a progressive decrease in enhancement until the microbubbles are no longer seen. Different enhancement patterns can help identify a lesion’s vascular composition, which can assist with lesion identification.

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Literature review current through: Nov 2017. | This topic last updated: Dec 12, 2017.
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