“Clinically compelling” study shows contrast-enhanced ultrasound (CEUS) is safe and saves lives

A comprehensive new study based on nationwide claims data from more than 11 million patients shows that diagnostic contrast-enhanced ultrasound (CEUS) exams are safe and can lower a patient’s risk of death.

The study, posted online today by the Journal of the American Heart Association, found that serious adverse events associated with ultrasound enhancing agents (UEAs) are “uncommon,” occurring in only 1:10,000 cases.

This is “an exceptionally strong safety profile,” according to the study’s lead author, Dr. Jordan Strom, Associate Professor of Medicine at Harvard Medical School, Director of the Echocardiography Laboratory at Beth Israel Deaconess Medical Center, and an officer of the International Contrast Ultrasound Society (ICUS).

The large, multicenter, nationwide dataset is broadly representative of US healthcare activity, according to the report. The results mirror those published a decade ago and “reassuringly suggest the continued safety of UEAs in practice,” the authors stated.

“This clinically compelling study shows that CEUS is very safe, even for our sickest patients, and saves lives,” said Dr. Steven Feinstein, a cardiologist and Co-President of ICUS.

CEUS is a reliable and cost-effective diagnostic tool used worldwide to diagnose heart and vascular disease, identify and characterize tumors, monitor chronic gastro-intestinal diseases, evaluate other serious medical conditions and monitor therapy, Dr. Feinstein said.

He noted that, unlike contrast agents used for MR or CT, the enhancing agents used in ultrasound exams do not contain dye, create no known risk of kidney damage or brain deposits, and do not expose patients or hospital staff to ionizing radiation. In addition, CEUS exams are often easier on patients, and they provide highly accurate clinical information in real time so that appropriate therapy can be initiated without delay.

Dr. Strom said that UEAs are underutilized in North America despite their well-established clinical and economic benefits, and he called upon more medical centers to offer CEUS to their patients.

“UEAs can help us get the right diagnosis upfront, reducing unnecessary and costly downstream testing – and that is not only great for patients, it also helps improve health care cost containment and efficiencies, providing a unique win-win opportunity to save money while actually improving clinical care and outcomes,” Dr. Strom added.

CEUS is also safe and useful for a wide range of radiology applications, said Dr. Stephanie Wilson, a radiologist at the University of Calgary and Co-President of ICUS.

“We use CEUS every day because it safely and consistently provides high resolution images comparable to – and sometimes better than – CT or MR,” Dr. Wilson said.

“Many of our patients cannot tolerate CT or MR, especially if they have kidney disease, so for them CEUS may be the only option for advanced imaging,” she added.

Key findings of the newly-published study, which covered a four-year period between 2018 and 2022, include:

• Serious adverse events associated with UEAs were uncommon (occurring in only 1:10,000 administrations).
• This relatively low risk was similar across brands of UEAs and years of study.
• This risk also was consistent with findings of older studies.
• Patients who received UEAs are often sicker than those who don’t receive them.
• Still, after accounting for differences among individuals, patients who received UEAs had lower risk of death within 2 days of receiving UEAs during an echocardiogram when compared to patients who did not receive UEAs during an echocardiogram.

The authors examined rates of anaphylaxis, myocardial infarction, ventricular tachycardia, cardiac arrest or death within 2 days of echocardiograms administered with and without UEAs.

The study concluded that the small rate of serious adverse events should be interpreted in the context of higher risks posed by other contrast media and thus should not preclude use. The authors also cautioned that appropriate processes should be in place to mitigate risk and respond urgently to potential anaphylactoid reactions.

A smaller study recently suggested that COVID-19 vaccinations may be linked to higher risk of serious adverse events with a single UEA, but the new nationwide analysis found no such link -- regardless of the agent or year of study evaluated, Dr. Strom said.

“Our findings should alleviate any residual safety concerns and make a strong case for broader use of UEAs in order to improve patient care and outcomes and save lives,” Dr. Strom said.

Three UEAs are currently approved by the US Food and Drug Administration for use in the United States: Definity (Lantheus); Lumason (Bracco Imaging) and Optison (GE Healthcare).

ABOUT ICUS:

The International Contrast Ultrasound Society (ICUS) is a nonprofit medical society dedicated to advancing the safe and medically appropriate use of contrast enhanced ultrasound (CEUS) to improve patient care globally. Membership in ICUS is free of charge and there is no fee for ICUS CME-accredited educational programs, newsletters or other resources.

To join ICUS and learn more about CEUS, download ICUS Connect and visit the ICUS website (www.icus-society.org).

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