How to Perform Intra-Operative Contrast-Enhanced Ultrasound of the Brain—A WFUMB Position Paper

F. Prada, I.G. Vetrano, A.G. Gennari, G. Mauri, A. Martegani, L. Solbiati, L.M. Sconfienza, E. Quaia, K.N. Kearns, M.Y.S. Kalani, M.S. Park, F. DiMeco, C. Dietrich

Research output: Contribution to journalArticlepeer-review


Intra-operative ultrasound has become a relevant imaging modality in neurosurgical procedures. While B-mode, with its intrinsic limitations, is still considered the primary ultrasound modality, intra-operative contrast-enhanced ultrasound (ioCEUS) has more recently emerged as a powerful tool in neurosurgery. Though still not used on a large scale, ioCEUS has proven its utility in defining tumor boundaries, identifying lesion vascular supply and mapping neurovascular architecture. Here we propose a step-by-step procedure for performing ioCEUS analysis of the brain, highlighting its neurosurgical applications. Moreover, we provide practical advice on the use of ultrasound contrast agents and review technical ultrasound parameters influencing ioCEUS imaging.

Original languageEnglish
Pages (from-to)2006-2016
Number of pages11
JournalUltrasound in Medicine and Biology
Issue number8
Publication statusPublished - 2021


  • Brain tumors
  • Central nervous system
  • CEUS
  • Contrast-enhanced ultrasound
  • Intraoperative ultrasounds
  • Neurosurgery
  • Neurovascular diseases
  • Tumors
  • Central nervous systems
  • Contrast enhanced ultrasound
  • Imaging modality
  • Intra-operative
  • Intraoperative ultrasound
  • Neurovascular disease
  • Position papers
  • Ultrasound of the brain
  • Ultrasonics
  • contrast medium
  • gadolinium
  • sulfur hexafluoride
  • acoustic amplitude
  • amplitude modulation
  • analytical error
  • artifact
  • blood brain barrier
  • brain function
  • brain tissue
  • clinical practice
  • computer assisted tomography
  • contrast enhancement
  • diagnostic accuracy
  • diagnostic test accuracy study
  • dura mater
  • dynamics
  • glioma
  • human
  • image analysis
  • image display
  • image plane signal loss
  • injection
  • instrument sterilization
  • intermethod comparison
  • intraoperative contrast enhanced ultrasound
  • intraoperative period
  • mechanical index
  • medical history
  • microbubble
  • neurosurgery
  • nuclear magnetic resonance imaging
  • parameters
  • postoperative period
  • practice guideline
  • preoperative period
  • pseudo enhancement
  • pseudo washout
  • quantitative analysis
  • reproducibility
  • Review
  • safety
  • surgical technique
  • time
  • ultrasound parameters
  • brain tumor
  • diagnostic imaging
  • echography
  • procedures
  • Brain Neoplasms
  • Contrast Media
  • Humans
  • Intraoperative Period
  • Neurosurgical Procedures
  • Ultrasonography


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