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: Over one-third of adults worldwide have steatotic liver disease (SLD), usually characterised by imaging-diagnosed hepatic steatosis (HS). We examined associations between HS and extra-hepatic disorders.

Methods: Adults participating in the study had cross-sectional assessments including anthropometry, fasting blood tests, cardiovascular and liver ultrasound assessment using the Canon i800 Aplio for B-mode imaging, liver attenuation imaging (ATI) and shear wave elastography (SWE). Severity of HS was measured using manufacturer guidance and HS was graded as [S0: <0.69; S1: 0.69-0.74; S2: 0.75-0.88; S3: >0.89 dB/cm/MHz].
Liver stiffness measurement (LSM) was examined using SWE. Gall bladder disease was defined by the presence of gallstones or a cholecystectomy, carotid atherosclerosis was determined using ultrasound-measured carotid intima media thickness (cIMT), hypertension and impaired fasting glucose/type 2 diabetes mellitus (IFG/T2DM) by self-report or fasting glycaemia.

Results: 491 adults with 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 gall bladder disease (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: In the study population, moderate-severe HS was significantly associated with IFG/T2DM and gall bladder disease but not with carotid atherosclerosis. Patients with known gallbladder disease and or T2D / pre-diabetes are more likely to demonstrate ultrasound appearances of liver steatosis.

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.

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.