The use of Contrast Enhanced Ultrasound (CEUS) is prevalent internationally and slowly becoming more routine in Australia.

It's great benefit is obtaining a definitive diagnosis of liver lesions at the time of ultrasound, preventing the need for CT/MRI workup. It can also be used to problem solve an inconclusive CT or MRI scan, allowing ultrasound to become the definitive diagnosis rather than a filter for other modalities.

Furthermore, ultrasound contrast agents are not nephrotoxic and have a significantly lower allergenic risk compared to other modalities. This coupled with the fact that ultrasound uses no radiation, allows CEUS to be a fantastic and safe addition to clinical practice.

This presentation outlines why CEUS should be an additional tool to the sonographer's skillset, how to perform CEUS, the benefits of CEUS and shares multiple cases where CEUS has been used at a large public tertiary hospital in South Australia.

Introduction: Hepatic steatosis (HS), gallstones and cholecystectomy have a bidirectional metabolic disorder relationship. It is unclear whether another cardiometabolic condition - carotid atherosclerosis is associated.
Methods: Assessment of adult participants included anthropometry, fasting blood tests and B-mode, attenuation imaging (ATI) and shear wave elastography (SWE) liver ultrasound. Severity of HS was graded as [S0: <0.69; S1: 0.69-0.74; S2: 0.75-0.88; S3: >0.89 dB/cm/MHz]. Gallstones or cholecystectomy were recorded together with carotid intima media thickness (cIMT), hypertension and impaired fasting glucose/type 2 diabetes mellitus (IFG/T2DM) by self-report or measured blood pressure and fasting glycaemia.
Results: 491 adults (mean age 64.6 (SD 5.6) years) had liver and carotid assessment. Compared with participants with absent/mild (S0/S1) HS, those with moderate-severe (S2/S3) HS had a higher likelihood of IFG/T2DM (unadjusted OR 3.27, 95% CI 1.51-7.06) and gallstones/cholecystectomy (unadjusted OR 1.95, 95% CI 1.17-3.25). Using multivariable logistic regression analysis, moderate-severe HS (OR 3.46, 95% CI 1.41-8.45, p=0.007) was the only significant variable associated with IFG/T2DM after adjusting for age, LSM, and serum ALT.
Conclusion: Moderate-severe HS was significantly associated with IFG/T2DM and gallstones/cholecystectomy but not with carotid atherosclerosis.
Take home message: People with T2DM are at increased risk of cirrhosis and hepatocellular cancer, while international and Australian guidelines recommend screening for fatty liver and liver fibrosis in these diabetics, this often overlooked. There is also a long-standing relationship between hepatic steatosis and gallstone disease, which is well known to hepatologists but possibly not to sonographers/radiologists, liver screening may also be of clinical benefit.

Introduction: Worldwide, obesity is reaching epidemic proportions and increasingly becoming a critical indicator of general morbidity, cardiovascular disease (CVD) and renal dysfunction. A promising trend in detection and management of obesity is the measurement of perirenal adipose tissue (PRAT), recognised as a metabolically active endocrine organ in itself. Its measurement by ultrasound can be used to indicate visceral obesity. This presentation aims to present the systematic review findings of current PRAT measurement techniques and their potential use as an indicator of CVD.
Methods: We included clinical studies published between 2010 and 2023, investigating the current ultrasonographic techniques, and the reliability and accuracy of included papers. The risk of bias was assessed using the Downs and Black Checklist, and methodological quality using the Grade tool.
Results: We found PRAT measures are highly predictive of CVD risk factors and the accuracy of ultrasound is comparable to CT and MRI, but there is no consistency in ultrasound technique. The lack of any randomised control trials and the use of 20 different non-standardised ultrasound techniques across the 21 studies resulted in inconsistent and imprecise clinical observations and interpretations.
Conclusion: This review found the inclusion of ultrasound measures in routine abdominal imaging potentially invaluable but demonstrates the need for standardisation of the PRAT ultrasound measuring technique to improve reproducibility and reliability.
Take home message: Ultrasound can be a valuable tool for PRAT measurement as an indicator of CVD.

The spleen is often considered the “forgotten organ” of the abdomen, as splenic diseases are thought to be less common and are often asymptomatic. However, due to advances in imaging technology, more splenic lesions are being identified. This presentation will discuss some of the congenital and acquired anomalies visusalised, as well as some of the more commonly seen pathological findings seen within the spleen.

This talk will cover the application of the Bosniak criteria to cystic renal lesions, features for differentiation and the use of contrast for further characterisation.