What is contrast-enhanced ultrasound (CEUS)?

Contrast-enhanced ultrasound (CEUS) is an imaging tool. It combines ultrasound and contrast agent. Ultrasound is an imaging test used to see inside the body. Contrast is a substance that has microbubbles in it. The microbubbles help providers see more clearly during an ultrasound exam. CEUS is free from radiation and doesn’t require sedation.

How does CEUS work?

Ultrasound uses sound waves to create images of the inside of the body. When the ultrasound probe (also called a transducer) is placed on the skin, images of body organs and soft issues are projected onto a computer screen.

In contrast ultrasound, a special kind of contrast agent made up of gas-filled microbubbles is injected into the body. The microbubbles make it much easier to see the inside of the body on the computer screen.

CEUS is as accurate as computed tomography (CT) and magnetic resonance imaging (MRI), without the same potential side effects. CEUS does not expose your child to radiation. It can be used often, allowing clinicians to get a better picture of your child’s organs and blood flow. Allergic reactions to ultrasound contrast are also less common than to other imaging contrast agents.

Benefits of CEUS

Contrast-enhanced ultrasound has a number of benefits to children including:

• Highly accurate diagnosis comparable to CT and MRI
• Real-time evaluation of blood flow
• No radiation exposure and fewer allergic reactions compared to other imaging agents
• Less need for sedation or general anesthesia
• Can be performed safely at the bedside
• No risk of causing kidney failure

What is contrast-enhanced ultrasound used for?

CEUS is FDA approved for use in pediatric patients suspected to have certain kidney, liver and heart conditions.

If your child’s specialist thinks contrast-enhanced ultrasound is the best imaging choice for your child, they will let you know.

If you feel your child would benefit from CEUS but you are not a current patient, please contact the Department of Radiology at 215-590-7000 for more information.

CEUS preparation

The steps you need to take to prepare for contrast-enhanced ultrasound vary depending on the body part being examined. We will give you specific instructions.

Other considerations

Dress your child comfortably, in clothes that are easily removed. Your child may be given a gown to change into for the procedure.

Your child will be lying down on a bed during the contrast-enhanced ultrasound. You may want to bring a stuffed animal, special blanket or other comfort items for your child to hold.

Note: Parents will be allowed to accompany their child into the exam room. It may be helpful to make other arrangements for siblings.

What to expect during a contrast-enhanced ultrasound exam

General

We know medical exams can be scary and stressful for kids. Our child life specialists will help you prepare and support your child during the CEUS procedure. We can also arrange to have a child life specialist at your child's pre-procedure appointment to explain the procedure in ways they’ll understand and help your child cope with the stress of the hospital experience.

Most contrast-enhanced ultrasound exams take about 30 to 60 minutes. The ultrasound technologist will explain the CEUS procedure to you and your child. Then, the technologist will ask your child to change into a gown or remove clothing to expose the area to be examined. Your child will then lie on the exam bed.

Once your child is settled, the technologist will begin the exam. In most cases, the technologist will turn off the lights in the room. This makes it easier to see the pictures on the computer screen. To begin imaging, the technologist will put a warm gel on the probe (also called a transducer) and on the part of your child's body being examined. The gel is clear and easily removable with water. It does not stain clothing. The technologist will glide the transducer over the parts of the body that the doctor wants to see.

The ultrasound is painless. Your child will feel the probe and the gel slide around on the area being examined. While viewing the images live, the ultrasound technologist will take a series of still images and short “movie clips” to send to the radiologist (the doctor) to review and interpret. In some cases, the radiologist may perform the ultrasound exam themselves.

After these first pictures are taken and reviewed by the radiologist, the contrast-enhanced portion of the exam will take place. More ultrasound pictures will be taken of the body parts that are being examined.

Intravenous CEUS examinations

The ultrasound contrast agent is given through an intravenous (IV) line or catheter. The method we use will depend on the part of the body being examined. The IV line or catheter will be inserted before the contrast-enhanced part of the examination, if one is not already in place.

Contrast-enhanced voiding urosonography CEVUS examinations

This examination is usually done to check for vesicoureteral reflux. First, ultrasound pictures will be taken of your child’s kidneys and bladder. Then, a catheter will be inserted into your child's bladder. The ultrasound contrast will be given through the catheter.

• To place the catheter in the bladder, your child will lay on the ultrasound bed with their legs in a "Frog Position" or "Butterfly Position."
• The technologist will wipe down the urethral area with three to four cotton balls soaked in "Brown Soap," which is an iodine-based cleaning agent. The soap may feel a bit cool.
• A tiny feeding tube or catheter will be placed into your child's bladder. Your child may feel some pressure and the urge to pee. As a relaxation technique during this process, we will ask your child to "blow out birthday candles" or take big, deep breaths.
• Once the catheter is placed, we will secure the tube to your child's leg with tape.
• The catheter will be connected to a saline solution. This solution has ultrasound contrast material in it. The contrast will flow through the urinary catheter into your child's bladder.
• Your child will lie on the exam table. They will face up or turn on their side so the sonographer can get the best pictures possible. The sonographer will take several ultrasound pictures of your child’s kidneys, ureters, bladder and urethra as the urinary bladder is filled with the contrast agent as well as while your child is urinating.
• Your child will need to remain still so the sonographer can get clear images of a certain area.
• Your child will be told to hold the contrast in even though they may feel the urge to pee. Once the bladder is full, the radiologist will ask your child to pee while still on the table. (Small children and infants will probably pee on their own.) We may supply a bedpan or a urinal, and/or sprinkle warm water on your child to help stimulate urination. Once your child starts to pee, more ultrasound pictures will be taken of your child’s urethra, bladder, ureters and kidneys.
• While your child is peeing, the catheter will slide out. Your child will not feel any discomfort. The sonographer will place the transducer over the lower belly to take clear images of the bladder and urethra. The sonographer might need to move the transducer over or near your child's private parts to take additional images of the urethra to complete the study.

CEUS test results

The images from your child’s contrast-enhanced ultrasound are interpreted on the same day by the radiologist. A report will be sent to your physician’s office. Your child’s specialist will  discuss the results with your family and determine next steps.