الفهرس 
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Abstract
Conventional ultrasound is the basic imaging procedure for endometrial examination, having definite advantages: obtaining real-time images, repeatability, low costs, etc. However, there are situations in which complex diagnosis requires the use of more sophisticated examination methods: Doppler ultrasound, 3D ultrasound, sonohysterography, etc. Over the past decade, contrast-enhanced ultrasound (CEUS) has gained increasing credibility.
Contrast-enhanced ultrasound is a special examination technique that gains more and more importance. This allows a detailed real-time evaluation of microcirculation in a certain territory, which is impossible to perform by Doppler ultrasound
The recent introduction of US contrast agents has totally changed the depiction of specific vascular signs for a definite diagnosis by allowing a marked increase in signal from the vessels, especially with modern non-linear imaging techniques. Contrast-enhanced ultrasound (CEUS) allows an adequate depiction of vessels in relation to the pure intravascular characteristics of those agents, reinforced by the real-time assessment of the enhancement after contrast injection. The recent availability of this imaging technique for transvaginal applications has allowed physicians to use CEUS in gynecology, such as in ovarian or uterine lesions, for a better assessment of vascular patterns that could play a role in diagnosis management.
Contrast specific imaging adds a high clinical value to ultrasound by allowing the differentiation between normal and pathologic tissue through the dynamic study of the micro- and macro-vasculature, the use of intravascular contrast agents can improve the detection of small vessels and low-volume blood flow.
Performing this type of ultrasound examination requires equipment capable of detecting contrast agents, modulating at the same time the acoustic power (mechanical index – MI) of the ultrasound beam. The physical principle on which CEUS examination is based is the phase reversal principle
CEUS consists of the bolus injection of the contrast agent into the cubital vein, in a dose of 1.6-2.4 mL, depending on the equipment used and the weight of the patient.
The arterial phase usually starts 10-15 seconds after the injection of the contrast agent and lasts up to 40 seconds, being followed by the venous phase.
Echogenicity during examination progressively increases and subsequently decreases (this phase is termed “wash-out”).
CEUS is useful in identifying the nature of endometrial lesions, getting more information about benign and malignant nature of the lesion and assessing the depth of myometrial invasion to provide a basis for preoperative selection of proper treatment options in clinical practice.
For the preoperative evaluation of patients with malignant endometrial tumors, conventional endo vaginal ultrasound, magnetic resonance imaging (MRI), endometrial biopsy, and more recently, contrast-enhanced ultrasound are used.
Conclusion:
Contrast-enhanced ultrasound is a special examination technique that allows a detailed real-time evaluation of microcirculation in a certain territory, which is impossible to perform by Doppler ultrasound.
Its practical applications of CEUS include: evidence of the vascular axis of very small polyps; assessment of the degree of intramyometrial invasion in endometrial cancer; alteration of the circulatory pattern in inflammatory lesions.