Diagnostic value and clinical utility of contrast enhanced ultrasound in intestinal diseases

Contrast enhanced ultrasound can facilitate the diagnosis of inflammatory mass causing stenosis and stricture. (a) The hypoechoic mass on the right side of the image was suspicious for abscess formation but contrast enhancement proved inflammatory mass lesion, hypovascular stricture shown in the arterial phase (b) and abscess formation shown by conventional B-mode (c) and using CEUS (d).

In patients with ulcerative colitis and left sided colitis the bowel wall is thickened (a). The hyperperfusion of the inflamed colonic segment becomes visible after injection of the contrast agent (b).

Color Doppler imaging is helpful in the understanding of the bowel wall architecture in gastrointestinal diseases, e.g., clearly delineating the submucosal vessels. Gray scale ultrasound depicts the normal sized appendix (5mm) (a), but color Doppler imaging allows a better understanding of the vessel architecture within the submucosa (b) indicating initial inflammation in the very early stage of appendicitis. Due to the improved sensitivity the same is true for contrast enhanced ultrasound also in difficult cases (c and d).

Contrast enhanced ultrasound can facilitate the identification of ischemic intestinal wall thickening (“ischämisch”) also in patients with inconclusive findings using color duplex imaging. Asymmetric bowel wall and “dirty bowel appearance” with loss of wall layer structure are indicative. Tissue contrast ultrasound signals are reduced or completely absent. Analysis of arterial enhancement is most important.