Practical Considerations for Providing Contrast-Enhanced Ultrasound Services

Contrast-enhanced ultrasound (CEUS) uses ultrasound contrast agents (UCAs), usually administered intravenously, to improve assessment of blood flow and tissue vascularity. UCAs are composed of microbubbles of gas that increase the reflectivity of blood and contrast-containing tissues. They improve ultrasound diagnoses and expand the clinical potential of the modality, and they have been commercially available for more than 20 years in the United States (Paefgen et al. 2015). However, until recently their FDA-approved indication was limited to cardiac applications: to opacify the left ventricular chamber of the heart in patients with suboptimal echocardiograms in order to enhance images of the ventricular endocardial border. For additional information regarding the use of contrast agents in echocardiography, see this Product Brief from ECRI Institute's Health Technology Assessment Information Service: Overview of Injectable Suspensions for Contrast-enhanced Echocardiography (membership required for access).

In April 2016, Lumason (Bracco Diagnostics, Princeton, NJ) became the first intravenously administered UCA to gain FDA approval for a noncardiac—or radiologic—indication: for characterization of focal liver lesions in adults and pediatric patients (Seitz and Strobel 2016). And the range of applications is likely to continue to grow. In addition, physicians can elect to use UCAs for off-label applications, and the use of UCAs in other countries is less restricted. A more in-depth description of contrast-enhanced ultrasound (CEUS) imaging technologies and noncardiac clinical applications is available in our article Advances in Diagnostic Ultrasound: Contrast-Enhanced Ultrasound Imaging.

The radiologic use of UCAs and contrast-specific imaging technologies may introduce new challenges for ultrasound service providers, but also offers potential benefits to those providers, as well as to patients and payers. Described below are the practical issues that need to be considered when establishing a CEUS service.

Although UCAs can be visualized using conventional B-mode ultrasound, CEUS should be performed using a scanner that supports contrast-specific ultrasound modes. Such modes have proven to greatly improve the diagnostic value of CEUS, and their use is recommended in established guidelines (Claudon et al. 2013, Porter et al. 2014, Piscaglia et al. 2012, Nolsoe and Lorentzen 2016, Sidhu et al. 2016). Contrast-specific software is available as a standard or optional feature on scanners from all of the major ultrasound vendors but, depending on the scanner used, may only be supported on specific transducers. Consult with your ultrasound scanner vendor to determine your requirements based on your...