Background: Ultrasound (US) is the modality of choice for the workup of many
vascular pathologies based on a plethora of advantages. However, US has inherent
limitations including limited spatial resolution, and lower sensitivity to slow
blood flow and vascular luminal irregularities. For evaluation of vascular
pathology, angiography has long been considered the gold standard. Cross-sectional
imaging techniques have gradually replaced angiography for the evaluation of many
vascular beds, currently being regarded as the diagnostic imaging modality of choice
for diagnosis of virtually almost every vascular disease leaving angiography mainly
for treatment purposes. The introduction of microbubbles as ultrasonographic
contrast agents has rendered contrast-enhanced ultrasound (CEUS) an evolving
valuable complementary technique with markedly increased diagnostic accuracy for
assessing both the macro- and microvascular anatomy of the vasculature. CEUS has a
safety profile which is much favorable when compared to other contrast agents. Due
to its superior spatial and temporal resolution, ability for prolonged scanning and
dynamic and real-time imaging, it provides clinically significant additional
information compared to the standard Duplex US. Method(s): In this
communication, we discuss the currently available literature regarding vascular
applications of CEUS, with special attention to the abdominal aorta, briefly
elaborate on CEUS technique and present cases in order to illustrate the added value
in the diagnosis and treatment of aortic pathologies. Result(s): CEUS enables
imaging of adventitial vasa vasorum providing additional clinical utility since
adventitial vasa vasorum has important implications in the pathogenesis of vascular
diseases. The recent advances of CEUS along with ongoing development of drug-eluting
contrast microbubbles has allowed improved targeted detection and real-time
ultrasound guided therapy for aortic vasa vasorum inflammation and
neovascularization in animal models. Conclusion(s): CEUS is uniquely suited
to comprehensively assess and potentially treat vascular diseases in the future.
