title: Contrast-enhanced ultrasound (CEUS) in nephrology: Has the time come for its widespread use?
abstract: Grey-scale ultrasound has an important diagnostic role in nephrology. The absence of ionizing radiations and nephrotoxicity, rapidity of execution, excellent repeatability, the possibility to perform the test at the patient's bed and the low cost represent important advantages of this technique. Paired with real-time sonography and colour-power-Doppler contrast-enhanced ultrasound (CEUS) reduces the diagnostic gap with computed tomography (CT) and magnetic resonance (MR) and represents a major step in the evolution of clinical ultrasound. Although there are several situations in which contrast-enhanced CT and MR are indicated (i.e. evaluation of cystic or ischemic lesions, traumatisms and ablative therapies of the native and transplanted kidney), the use of CT contrast media presents a high risk of contrast-induced nephropathy (i.e. in elderly people, subjects with comorbidities and those with renal dysfunction), while gadolinium-based RM contrast agents are contraindicated for the risk of nephrogenic systemic fibrosis (i.e. in patients with severe renal dysfunction). In these situations, CEUS may be a viable alternative, however, as any technique associated with the infusion of pharmacological substances, the potential advantages and risks of CEUS should be critically evaluated. In this regard, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has published the guidelines for the use of CEUS for the kidney imaging and the International Contrast Ultrasound Society (ICUS) has been recently founded. The aim of this review is to offer an updated overview of the potential applications of CEUS in nephrology, reporting some indications and possible risks associated to its use.
authors.affiliation: Nephrology and Dialysis Unit, "St. Giovanni di Dio" Hospital, Agrigento, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Granata
authors.forename: Luca
authors.initials: L
authors.lastname: Zanoli
authors.forename: Monica
authors.initials: M
authors.lastname: Insalaco
authors.forename: Massimo
authors.initials: M
authors.lastname: Valentino
authors.forename: Pietro
authors.initials: P
authors.lastname: Pavlica
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Di Nicolò
authors.forename: Mario
authors.initials: M
authors.lastname: Scuderi
authors.forename: Fulvio
authors.initials: F
authors.lastname: Fiorini
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fatuzzo
authors.forename: Michele
authors.initials: M
authors.lastname: Bertolotto
mesh_terms: D003287:Contrast Media; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging*; D009398:Nephrology / Q000379:methods*; D014463:Ultrasonography
chemical_list: D003287:Contrast Media