To illustrate the spectrum of novel clinical applications of contrast-enhanced ultrasound (CEUS) in both non-vascular and vascular radiological interventional procedures. To outline the advantages and techniques of CEUS guided intervention Through a problem-orientated approach, we aim to demonstrate that CEUS not only can be utilised safely and effectively in radiological intervention, but could also provide unique solutions to complex clinical problems.

‘Interventional Ultrasonography’ – Why? One of the proven technology in imaging-guided, minimally invasive procedures is with ultrasound. Ultrasound-guided intervention: Eliminates the need for iodinated contrast agents. This is especially important for patients with renal insufficiency not yet on dialysis in whom iodinated contrast or gadolinium-based MRI contrast exposure could be detrimental, or those with severe allergy to iodinated contrast medium, Itavoids the problems associated with radiation exposure for both patients and treating clinicians and Significantly, Portable. in unstable patients where ‘bedside’ procedures can be advantageous....

Extravascular (Intracavitary) CEUS Intervention Applications General Principles: Ultrasound contrast agentscan be instilled into any physiological or pathological body cavity to assess morphology of the cavity and potential communications with adjacent structures or organs. Artefacts have to be avoided: This can be achieved by using low concentration of contrast agent with adequate dilution (e.g.0.1 – 0.5 mL SonoVue® in 100 - 500 mL 0.9% saline). Novel Clinical Applications: CEUS Guided Percutaneous Nephrostomy (PCN) and Nephrostogram Clinical Challenges: The major problem with ultrasound-guided PCN is localisation of...

Novel application of CEUS in interventional radiology is frequently performed on demand, to address specific cllinical questions raised in the individual patient. Use of CEUS must be decided on a case-by-case basis, usually resorting to CEUS because of inconclusive standard diagnostic techniques or when patients are not suitable for these or because they have higher risks (for instance, use of ionising radiation on sensitive organs, or moving the patient out of intensive care units) or more complex logistic situations. In appropriate cases, CEUS not only...

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Dr. Dean Huang BMedSci BMBS MRCPCH FRCR EBIR Consultant Radiologist King'sCollegeHospital Denmark Hill LondonSE5 9RS Tel: 0203 2994599/4164 Fax: 0203 2993157 email: [email protected]