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CEUS Technique: Artifacts and Pitfalls
David Fetzer, MD; Christoph F. Dietrich, MD, MBA, PhD
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KEY FACTS

  • Image Artifacts

    • Pitfalls

      TERMINOLOGY

      • Image Artifact

        • Finding or feature within image that is not directly related to object being imaged
        • Artifacts may be intrinsic to imaging modality or may be due to operator error or natural processes within object being imaged
        • Artifacts need to be differentiated from real anatomical structures, as they can simulate pathology
        • Some artifacts may be useful, leading to more confident diagnosis
      • Technical Terms

        • Low mechanical index (MI) US contrast imaging mode allows for contrast-only image, often displayed in sepia hue side by side with low-MI B-mode image
        • Image gain, sometimes referred to as image brightness, adjusts overall amplification of signal from returning reflections
        • MI is US bioeffects metric used to estimate likelihood of biomechanical effects, such as tissue cavitation due to rapid changes in pressure

      INTRODUCTION

      • CEUS Technique

        • Microbubble Contrast

          CLINICAL IMPLICATIONS

          • Imaging Artifacts

            B-MODE IMAGING ARTIFACTS

            • Observed in Contrast Mode

              DOPPLER IMAGING ARTIFACTS

              • Color Doppler Blooming

                • Pulsed Wave Doppler Waveform Degradation

                  CONTRAST-MODE IMAGING ARTIFACTS

                  • Background Noise

                    • Unintended Microbubble Destruction

                      • Signal Saturation

                        • Attenuation/Shadowing

                          • Nonlinear Artifacts

                            • Prolonged Heterogeneous Liver Enhancement

                              TROUBLESHOOTING

                              • Poor Enhancement

                                • Contrast-Mode Image Too Bright

                                  • Contrast-Mode Image Too Dark

                                    Selected References

                                    1. Fetzer DT et al: Artifacts in contrast-enhanced ultrasound: a pictorial essay. Abdom Radiol (NY). 43(4):977-997, 2018
                                    2. Jo PC et al: Integration of contrast-enhanced US into a multimodality approach to imaging of nodules in a cirrhotic liver: how I do It. Radiology. 282(2):317-331, 2017
                                    3. Denham SL et al: Contrast-enhanced ultrasound: practical review for the assessment of hepatic and renal lesions. Ultrasound Q. 32(2):116-25, 2016
                                    4. Cui XW et al: Prolonged heterogeneous liver enhancement on contrast-enhanced ultrasound. Ultraschall Med. 35(3):246-52, 2014
                                    5. Dietrich CF et al: Artifacts and pitfalls in contrast-enhanced ultrasound of the liver. Ultraschall Med. 35(2):108-25; quiz 126-7, 2014
                                    6. Dietrich CF et al: Pitfalls and artefacts using contrast enhanced ultrasound. Z Gastroenterol. 49(3):350-6, 2011
                                    7. Yu H et al: Pseudoenhancement within the local ablation zone of hepatic tumors due to a nonlinear artifact on contrast-enhanced ultrasound. AJR Am J Roentgenol. 194(3):653-9, 2010
                                    8. Gutberlet M et al: Do ultrasonic contrast agents artificially increase maximum Doppler shift? In vivo study of human common carotid arteries. J Ultrasound Med. 17(2):97-102, 1998
                                    9. Forsberg F et al: Artifacts in ultrasonic contrast agent studies. J Ultrasound Med. 13(5):357-65, 1994
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Image Artifacts

                                      • Pitfalls

                                        TERMINOLOGY

                                        • Image Artifact

                                          • Finding or feature within image that is not directly related to object being imaged
                                          • Artifacts may be intrinsic to imaging modality or may be due to operator error or natural processes within object being imaged
                                          • Artifacts need to be differentiated from real anatomical structures, as they can simulate pathology
                                          • Some artifacts may be useful, leading to more confident diagnosis
                                        • Technical Terms

                                          • Low mechanical index (MI) US contrast imaging mode allows for contrast-only image, often displayed in sepia hue side by side with low-MI B-mode image
                                          • Image gain, sometimes referred to as image brightness, adjusts overall amplification of signal from returning reflections
                                          • MI is US bioeffects metric used to estimate likelihood of biomechanical effects, such as tissue cavitation due to rapid changes in pressure

                                        INTRODUCTION

                                        • CEUS Technique

                                          • Microbubble Contrast

                                            CLINICAL IMPLICATIONS

                                            • Imaging Artifacts

                                              B-MODE IMAGING ARTIFACTS

                                              • Observed in Contrast Mode

                                                DOPPLER IMAGING ARTIFACTS

                                                • Color Doppler Blooming

                                                  • Pulsed Wave Doppler Waveform Degradation

                                                    CONTRAST-MODE IMAGING ARTIFACTS

                                                    • Background Noise

                                                      • Unintended Microbubble Destruction

                                                        • Signal Saturation

                                                          • Attenuation/Shadowing

                                                            • Nonlinear Artifacts

                                                              • Prolonged Heterogeneous Liver Enhancement

                                                                TROUBLESHOOTING

                                                                • Poor Enhancement

                                                                  • Contrast-Mode Image Too Bright

                                                                    • Contrast-Mode Image Too Dark

                                                                      Selected References

                                                                      1. Fetzer DT et al: Artifacts in contrast-enhanced ultrasound: a pictorial essay. Abdom Radiol (NY). 43(4):977-997, 2018
                                                                      2. Jo PC et al: Integration of contrast-enhanced US into a multimodality approach to imaging of nodules in a cirrhotic liver: how I do It. Radiology. 282(2):317-331, 2017
                                                                      3. Denham SL et al: Contrast-enhanced ultrasound: practical review for the assessment of hepatic and renal lesions. Ultrasound Q. 32(2):116-25, 2016
                                                                      4. Cui XW et al: Prolonged heterogeneous liver enhancement on contrast-enhanced ultrasound. Ultraschall Med. 35(3):246-52, 2014
                                                                      5. Dietrich CF et al: Artifacts and pitfalls in contrast-enhanced ultrasound of the liver. Ultraschall Med. 35(2):108-25; quiz 126-7, 2014
                                                                      6. Dietrich CF et al: Pitfalls and artefacts using contrast enhanced ultrasound. Z Gastroenterol. 49(3):350-6, 2011
                                                                      7. Yu H et al: Pseudoenhancement within the local ablation zone of hepatic tumors due to a nonlinear artifact on contrast-enhanced ultrasound. AJR Am J Roentgenol. 194(3):653-9, 2010
                                                                      8. Gutberlet M et al: Do ultrasonic contrast agents artificially increase maximum Doppler shift? In vivo study of human common carotid arteries. J Ultrasound Med. 17(2):97-102, 1998
                                                                      9. Forsberg F et al: Artifacts in ultrasonic contrast agent studies. J Ultrasound Med. 13(5):357-65, 1994