Contrast-Enhanced Sonography Detects 91% of Abdominal Organ Injuries
Interpreting Warranties: Four Questions for Axess Ultrasound
Product Showcase: Ultrasound Thrives with Advancements from Three Vendors

Contrast-Enhanced Sonography Detects 91% of Abdominal Organ Injuries

A study in the September issue of the American Journal of Radiology reported that contrast-enhanced sonography detected 41% more of hepatic, splenic, and renal injuries than did non-contrast-enhanced sonography, which detected only 50% of 22 injuries.1 Injuries initially were identified using contrast-enhanced CT; sonographic conspicuity of the injuries was graded on a scale of 0 (nonvisualization) to 3 (high visualization). The use of contrast during sonography increased the conspicuity of spleen injuries from 0.67 to 2.33, and increased the conspicuity of liver injuries from 1.0 to 2.2.

Figure 1. Shown here is a splenic laceration with subcapsular hematoma in a 46-year-old woman. A) This CT scan shows a large splenic laceration with surrounding subcapsular hematoma. B) This longitudinal noncontrast-enhanced sonogram shows a central heterogeneous region (arrow) with a normal-appearing spleen posteriorly and a subcapsular hematoma anteriorly. C) This longitudinal contrast-enhanced sonogram shows that splenic tissue noted posteriorly appears perfused and echogenic. The central region (arrow), which is nonperfused, is more hypoechoic and corresponds to region of splenic laceration. The more anterior hypoechoic region corresponding to subcapsular hematoma remains hypoechoic. Reprinted with permission from the American Roentgen Ray Society (ARRS).

“Because of all the FDA regulations, this was the first large study that we did using contrast in our patients at our institution,” says lead author John P. McGahan, MD, director of abdominal imaging at the University of California, Davis School of Medicine, Sacramento. “We had to go ahead and get our internal review board to approve use of the Definity contrast.” SH U 508A (Definity) is manufactured by Bristol-Myers Squibb Medical Imaging Inc, North Billerica, Mass.

McGahan believes in the potential of contrast-enhanced ultrasound. “I think for trauma patients, it plausibly could be used in two settings,” he says. “One is if we have a very sick patient, too sick to be brought back down from the ICU to the CT suite; in that instance, it’s plausible that we could go ahead and actually use contrast. The other thing is, we just did a study on the use of a FAST [focused abdominal sonography for trauma] scan on patients going directly to the OR, bypassing CT. It could be possible to inject one dose of contrast, look at a patient’s liver, spleen, and kidneys quickly, to see if there’s any big laceration. Then, the surgeon could go into that area first rather than doing a general exploration.”

McGahan’s study was conducted using an Acuson Sequoia ultrasound unit from Siemens Medical Solutions, Malvern, Pa, and two 0.1 mL doses of Definity contrast. For control findings, McGahan used a LightSpeed 16 CT system from GE Healthcare, Waukesha, Wis, enhanced with 120 to 150 mL of Omnipaque (iohexol) from GE Healthcare Medical Diagnostics, Princeton, NJ. The contrast-enhanced sonography detected 91% of the injuries detected by the CT, suggesting that in many cases, ultrasound technology could be substituted for CT if necessary.

“With a young patient, there’s no doubt that if we could get comparable information from a contrast ultrasound, compared to a contrast CT, that’s probably the way to go,” McGahan says. “Given the fact that you may have certain patients you don’t want to radiate all the time, or patients who can’t be moved to the CT scanner easily, ultrasound does have certain advantages.”

McGahan also speculates as to whether ultrasound could be superior to CT in certain cases. “Are there cases where ultrasound may provide additional information that we may not see with CT?” he wonders. “Are there other lesions that we may pick up with ultrasound? Before resection, if we do a contrast ultrasound, do we pick up three additional metastases? Certainly, people have shown that intraoperative ultrasound may add to the CT scan in picking up very small metastases.”

Also, the use of ultrasound is more widespread than CT; any new use of existing sonography technology has the potential to be highly beneficial. “It’s the most common cross-sectional imaging procedure performed worldwide,” McGahan notes. “Some countries only have a few CT scanners, but lots of ultrasound machines are out there.”


  1. McGahan JP, Horton S, Gerscovich EO, et al. Appearance of solid organ injury with contrast-enhanced sonography in blunt abdominal trauma: preliminary experience. AJR Amer J Radiol. 2006;187:658?666. Available at: content/abstract/187/3/658. Accessed November 6, 2006.

Interpreting Warranties: Four Questions for Axess Ultrasound

Axess Ultrasound Inc, Indianapolis, recently announced that it has expanded its warranties on parts to a full year, while maintaining a 6-month warranty on transducers. Medical Imaging spoke with Don Trombatore, director of new business development at Axess, about what it takes to provide a year of warranty service to customers.

MI: How long was the parts warranty that Axess offered before?

Trombatore: It used to be 6 months. Basically, our data was showing us that we were not having any failures of significance for 1 year, so we thought that we would extend the warranty period. That’s really what the basis of the decision was—that there’s very little risk of parts failing in that period of time. And we knew that our customers would be impressed and intrigued with the change.

MI: Why doesn’t Axess offer a full-year warranty on transducers? Is it just because they take more abuse?

Trombatore: A lot of it depends on the particular customer and the particular type of transducer. We have some customers who never go through multiple probes. They realize how expensive and fragile they are, and they treat them like they’re made out of gold. Conse-quently, we seldom have to replace any. However, we have other customers, particularly those in hospital environments or mobile groups, who go through probes constantly. That’s the nature of the beast; they have a lot of drops. The data basically shows us that it would not be in our best interest [to offer a full-year warranty on transducers], and that’s why no one out there offers a full year on probes across the board. We’re considering offering a full year on some probe types, because our data supports that.

MI: What is the industry standard as far as warranties go?

Trombatore: It’s kind of an ever-evolving situation. We rely strictly on the data—how many of the parts we ship come back on warranty exchange. Offering the year to our customers is a way of saying, “Hey, our parts are very high-quality.”

MI: So, users can look at a warranty as a bet on the part of the company, saying, “We have data showing that these parts last at least 1 year.”

Trombatore: Yes. And if our data shows that certain parts are lasting even longer than that, we would not be opposed to extending our warranties even further. We don’t want to put our customers at risk. We feel that if you stand behind your product, your customers will continue to come back to you. And that’s really what we’re banking on.

Product Showcase: Ultrasound Thrives with Advancements from Three Vendors

GE Healthcare, Waukesha, Wis; Philips Medical Systems, Andover, Mass; and Siemens Medical Solutions, Malvern, Pa, all have made improvements and/or new releases in the field of ultrasound. Here, we round up the latest news in ultrasound products.

Logiq P5 from GE Healthcare

The Logiq P5 offers the advanced ultrasound capabilities of GE Healthcare?s Logiq line in a streamlined, portable package.

The newest ultrasound system from GE Healthcare, the Logiq P5, maintains the performance standards of the company’s other Logiq products inside a smaller, more streamlined package. The portable unit features advanced applications combined with the ease of maneuverability of midsize units, and features:

  • High-Definition Speckle Reduction Imaging (HD-SRI) for high-definition contrast resolution that suppresses speckle artifact while maintaining tissue architecture;
  • CrossXBeam spatial compounding, which enhances tissue and border differentiation with an exclusive spatial-compounding acquisition and processing technique; and
  • 4D imaging for acquisition of 3D images in real time.

The Logiq P5 is built on TruScan system architecture, which allows the system to store raw data early in the imaging chain for powerful postprocessing and analysis; access to raw image data allows users to compensate for variations in image acquisition, reducing the need for rescans.

Half the weight and size of most console-based systems for improved maneuverability, the system features the SonoErgonomics design, which offers user-friendly functions like a full-size keyboard, hot keys, and user-defined keys.

Vision 2007 and Performance 2007 from Philips Medical

This 3D aplical view cardiac image displaying congestive heart failure was taken by the Philips Medical iE33 ultrasound system.

Philips Medical offers two new enhancement suites for ultrasound: Vision 2007 and Performance 2007. Vision 2007 upgrades both the iU22 ultrasound and iE33 echocardiography systems; Performance 2007 improves the HD11 XE, the HD3, and the EnVisor systems.

The iU22 with Vision 2007 features iSlice, a multislice display for quick review of volumetric data; physicians can choose from 4, 9, 16, or 25 image displays, and 2D images are updated as the volume is rotated. Vision 2007 for the iU22 also includes a new set of clinical capabilities for interventional procedures, protocol-driven exam technology, three new transducers for different applications, quantification abilities, and spatio-temporal image correlation for fetal heart evaluation. The iE33 enhanced with Vision 2007 offers a real-time 3D transducer optimized for pediatric echo examinations.

This iSlice display of abnormal groin lymph node was taken with the iU22 ultrasound. Both the iE33 and the iU22 are equipped with Vision and Performance 2007 enhancements.

Performance 2007 upgrades Philips Medical’s ultrasound systems in various ways. It brings Invert Imaging to the HD11 XE, providing a volume-display method for direct visualization of anechoic structures; the HD11 XE also can be enhanced with iSlice. The HD3 mobile ultrasound system now has a larger monitor, an optional transducer adapter, and a new transducer for vascular and neonatal cephalic applications. And now, the EnVisor system is equipped for improved intercostal access with a new transducer, as well as Anatomical M-mode for accurate measurement of chambers, walls, and ejection fraction.

Upgraded Antares 4.0 from Siemens Medical

Siemens Medical has released version 4.0 of the Acuson Antares ultrasound system, which boasts shared-service cardiology applications, an array of general imaging applications, and such advanced clinical applications as 3D/4D and contrast agent imaging.

V4.0 of the Acuson Antares from Siemens Medical features shared-service cardiology applications in addition to general imaging applications and advanced clinical applications.

V4.0 was structured around customer needs: The platform features advanced workflow and diagnostic capabilities, as well as a high-resolution 19-inch flat-panel display mounted on an articulating arm for optimal viewing position and other ergonomic design features.

Other V4.0 features include a full suite of Hanafy Lens and Multi-D array transducers; Clarify vascular enhancement technology; and TEQ ultrasound technology to optimize both 2D and spectral Doppler images. The new system also boasts fourSight 4D ultrasound imaging technology, SieScape panoramic imaging, SieClear multi-view spatial compounding, Cadence contrast pulse sequencing, and an enhanced screen layout.

Current Sonoline and Antares customers can easily upgrade to the new release.