(CEUS) Contrast agents increase the reflection of ultrasonic energy, improve the signal to noise ratio and caused by that the detection of abnormal microvascular and macrovascular disorders. Contrast enhanced ultrasound is used in abdominal ultrasound (liver sonography) as well as in cerebrovascular examinations e.g., for an accurate grading of carotid stenosis. The used contrast agents are safe and well tolerated.

The quality of the enhancement depends on:
The additional use of ultrasound contrast agents (USCAs) may overcome typical limitations like poor contrast of B-mode imaging or limited sensitivity of Doppler techniques. The development of new ultrasound applications (e.g., blood flow imaging, perfusion quantification) depends also from the development of pulse sequences for bubble specific imaging. In addition, contrast enhanced ultrasound improves the monitoring of ultrasound guided interventions like RF thermal ablation.

See also Contrast Enhanced Doppler Imaging, Contrast Harmonic Imaging, Contrast Imaging Techniques and Contrast Pulse Sequencing.

Duplex ultrasonography (duplex scan) consists of two ultrasound modalities to study blood flow and the perivascular tissue. This includes B-mode / gray scale imaging used in combination with spectral Doppler / pulsed-wave Doppler.
The real-time visualization of the vessels and tissue by the B-mode component improves the PW Doppler positioning and the direction of blood flow can be inferred. The angle between the direction of the PW Doppler signal and the estimated direction of blood flow can be measured.
Duplex techniques are available on phased array, linear array, and mechanical scanners. A phased array probe is able to create nearly simultaneous images and flow information. A linear array transducer can also do this if the Doppler probe is attached separately to one end of the scanhead. A mechanical transducer freeze the image; the crystals must be static to produce a Doppler image. The first two transducers are therefore the best choice for Duplex.

See also Compound B-Mode, and Duplex Scanner.

Echography (also called sonography) allows visualizing deep structures of the body by recording the reflections (echo) of ultrasound waves directed into the tissues. A medical diagnostic sonogram (echogram), as in echocardiography and echoencephalography, utilizes a frequency range of 1 to 10 MHz.

The usual applications of endocavitary echography (also called internal echography / endoscopic ultrasound (EUS)) are examinations of the pelvic organs through internally introduced probes, which give a more precise and correct image.
Transrectal ultrasound is a well established method for rectal or prostate carcinoma assessment.
A transvaginal echography uses a small transducer that is inserted directly into the vagina.
Used are high-frequency (10-12 MHz) for superficial organs, endocavitary echography, and intraoperative laparoscopic ultrasound. A sterile cover is slipped over the probe, which is then covered with lubricating ultrasound gel and placed in the cavitary (see Equipment Preparation).

See also Endoscopic Ultrasound, Prostate Ultrasound, Interventional Ultrasound, Transurethral Sonography, Vaginal Probe, Rectal Probe.

Sonography of the gallbladder is a reliable technique for diagnosing e.g., gallstones, cholecystitis, tumors, polyps, or ductal obstruction. Patient should be examined with empty stomach and on a low fat diet the night before. Barium studies, endoscopy, ERCP, colonoscopy, and abdominal CT should be performed after this examination.
Gallbladder ultrasound is best performed with a 5 MHz curved array or a linear array transducer in cases of a very superficial gallbladder. In obese patients or in patients with difficult sonographic access, a 3.5 MHz sector or curved linear transducer is advantageous.
Gallbladder and biliary tree are usually imaged in supine and posterior oblique (LPO) positions. Sometimes very small gallstones are better visible in upright and prone position.