E1910. Wash Away Your Troubles with Bubbles: Contrast-Enhanced Ultrasound (CEUS) Guided Procedures
  1. Kelly von Beck; Vanderbilt University Medical Center
  2. Mariam Moshiri; Vanderbilt University Medical Center
  3. Arthur Fleischer; Vanderbilt University Medical Center
  4. Virginia Planz; Vanderbilt University Medical Center
Ultrasound contrast agents (UCAs) allow for assessments of lesion enhancement like CT or MRI with additional advantages including real-time assessment, lack of nephrotoxicity, high safety profile, and the ability to perform multiple injections during a single examination. When administered intravenously, UCAs remain intravascular and extracellular, act as markers of perfusion, and have the ability to circulate through small vascular beds such as capillaries. UCAs are a valuable adjunct to ultrasound-guided interventions and allow visualization of lesions that may not be apparent on standard ultrasound during biopsy or ablation. UCAs can also be introduced into non-vascular sites such as abscesses, the renal collecting system, and the biliary tree. Thus, it has multiple intracavitary interventional applications including placement of abscess drains, nephrostomy tubes, or biliary drains. We aim to describe and illustrate the utility of CEUS during image-guided interventions using a case-based approach as well as common pitfalls of CEUS. We will offer a step-by-step guide with some tips for optimizing the use of CEUS during procedures.

Educational Goals / Teaching Points
The teaching session will begin with a review of available ultrasound contrast agents and a discussion of the unique advantages of CEUS for image-guided intervention. The technique for performing CEUS will be described step-by-step, including recommended dosage and necessary equipment. Next, the application of CEUS to specific procedures such as biopsies, percutaneous thermal ablation, abscess drain placement and repositioning, nephrostomy tube placement, and biliary drain placement will be reviewed as well as tips and tricks to ensure success (compression, positioning, artificial ascites). We will close with a discussion on how to avoid common pitfalls of CEUS for procedures (accelerated bubble destruction, artifacts) and a table summarizing recommendations for utilization.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will be reviewing the utility of contrast-enhanced ultrasound during US-guided procedures including biopsy (hepatic, renal), ablation (hepatic, renal), abscess drain placement and reposition, nephrostomy tube placement, and biliary drain placement.

At the conclusion of this session, learners will have a detailed understanding of the utility of contrast-enhanced ultrasound during procedures such as biopsy, ablation, and intracavitary interventions.