When to Recommend Contrast Enhanced Ultrasound

Indeterminate RENAL lesion seen on any modality:

• Recommend CEUS as first line study for definitive evaluation if the lesion can reasonably be expected to be visible on US.

       * This requires your experience and judgment but small lesions in large patients are hard, posterior lesions are easier than anterior, etc.

• More strongly recommend CEUS if the patient can’t have CT or MRI.
• As on the white paper documents, non-con US is not a first-line recommendation to see if the lesion is a simple cyst. I’d recommend CEUS in those cases. We routinely get grayscale images before putting in the IV and can cancel the contrast if the routine US is diagnostic.

Indeterminate LIVER lesion seen on any modality:

o Recommend CEUS for any patient who can’t have MRI or MRI contrast IF the lesion can reasonably be expected to be visible on US. o Lesions high in the liver dome can be tricky and small lesions in large patients are hard. o CEUS has been shown to be a little more accurate than CT but probably not as good as MRI.

Notes: o Great option for pregnant patients (Pregnancy class B) o Great option for patients with renal failure o Great option for patients who can’t be still in the MRI