Cardiovascular – Heart

  • Heart Intro
  • Guidelines
  • Exam Protocols
  • Bibliography

Contrast-enhanced ultrasound (CEUS) can dramatically improve the detection of coronary artery disease and stratify risk of heart attack or stroke.

CEUS is safe, accurate, completely avoids exposure to ionizing radiation, and can change patient outcomes and save lives. In addition, by salvaging non-diagnostic ultrasound examination, CEUS can help avoid unnecessary downstream tests and lower overall health care costs. Further, like conventional ultrasound examinations, CEUS is portable and easily accessible in a variety of clinical settings, provides real time diagnostic information that can speed access to appropriate therapy, and may improve workflows and efficiencies.

CEUS uses ultrasound contrast agents (UCAs), also known as ultrasound enhancement agents, to improve the clarity and reliability of conventional ultrasound scans. UCAs are comprised of liquid suspensions of biodegradable gas-filled microspheres (sometimes called “microbubbles”). When they are injected into a patient’s arm vein during an ultrasound exam, they flow through the body’s microcirculation without impediment, and are metabolized and expelled from the body within minutes.

Unlike agents used for other types of medical imaging, UCAs do not contain dye or present a risk of kidney damage.

UCAs are now integral components of ultrasound imaging throughout the world, and are approved for use in adult and pediatric imaging by the US Food and Drug Administration, the European Medicines Agency, and their counterparts in Asia, the Americas and elsewhere.

FDA-approved cardiac applications are limited to evaluation of the left ventricle of the heart and endocardial borders. However, CEUS scans may have significant diagnostic value with no added safety risk when used off-label during cardiac stress echocardiography and perfusion imaging studies. The Intersocietal Accreditation Commission guidelines for accrediting adult echocardiography laboratories requires the use of an UCA during stress echocardiography under certain specified conditions.

Under certain circumstances, CEUS may be superior to nuclear imaging or conventional ultrasound without a contrast agent. Nuclear scans generally have poorer spatial and temporal resolution and expose patients to ionizing radiation.

The following objectives and protocols for 2022 (Portuguese edition available here) reflect clinical CEUS practice in many medical centers throughout the world.

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