Editor’s Introduction: The Brave New World of Ultrasound Contrast

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It is a very exciting time in the world of ultrasound. After years amounting to more than a decade, contrast agents have finally been approved for use in abdominal ultrasound by the Food and Drug Administration, liver specifically, although many institutions are now using contrast for many examinations besides livers. The addition of contrast to the ultrasound armamentarium opens doors to a variety of clinical examinations that have been designated to the realm of computed tomography (CT) and magnetic resonance (MR) almost exclusively. The characterization of liver lesions, renal masses, portal and renal veins' patency, detection and staging of inflammatory bowel, and risk stratification of ovarian masses are all possible now. In particular, patients with renal function impairment and/or allergies to contrast can now have a diagnostic procedure performed with ultrasound that is on par in diagnostic use to that of CT and MR. Hence, the use of contrast in ultrasound marks a significant advance for our field.
However, we as an organization representing radiologists who perform ultrasound examinations need to ensure that the proper indications for contrast are followed and that the use of it is appropriate. Already in our institution, we have been receiving requests with “ultrasound of the liver, with and without contrast,” like it is a CT or MR examination, and this is not appropriate. As we move forward into the world of contrast ultrasound, we all need to triage requests for the proper selection of indications and patients mainly to ensure the success of contrast ultrasound in improving patient care, making accurate diagnoses while decreasing health care costs and decreasing hospital admission times. We also need to ensure that we as radiologists are the ones doing these examinations because the physics, instrumentation, imaging, and technologic aspects of contrast-enhanced ultrasound are more in line with our training than that of other specialties. We do face significant challenges not only from outside radiology but also within our department, making the switch from CT and MR to US that needs to be navigated to so that these examinations stay within our department and do not migrate into other medical specialties.
The issue begins with a review article regarding measurements in patients with cancer with ultrasound. While I have written previously about commoditization in radiology, measurements do need to be performed properly no matter who does them, and this article makes a valuable contribution in describing how this should be performed. With the new frontier of ultrasound contrast in mind, Ultrasound Quarterly is very pleased to present the timely wonderful article by Stephanie Wilson regarding the use of contrast in patients with contraindications to CT contrast agents. No one has promoted the use of ultrasound contrast more than Stephanie during the years, and no one is a better spokesperson for our specialty than she. Multiple research articles regarding procedures such as cervical lymph node biopsies in patients with lung cancer, knee injections using in-plane ultrasound guidance, and native kidney biopsies using an axial rather than sagittal approach follow. The effect of amniotic fluid volume measurements on fetal weight estimates, ultrasound appearance of absence of the vas deferens, ultrasound in steatofibrosis models of liver disease, preoperative diagnosis of retroperitoneal fibrosis, juvenile papillomatosis, and use of tomosynthesis and ultrasound in the diagnosis of breast cancers all follow. SRU cases and, as always, the very useful reviews of literature from outside radiology regarding ultrasound complete the issue.

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