Safety Profile of Musculoskeletal Contrast-Enhanced Ultrasound with Sulfur Hexafluoride Contrast Agent

Christian Fischer,1,* Pierre Kunz,1,* Marten Strauch,1 Marc-André Weber,2 Julian Doll1 1Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG - Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg 69118, Germany; 2Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock 18057, Germany*These authors contributed equally to this workCorrespondence: Julian DollCenter for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center HTRG – Heidelberg Trauma Research Group Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg 69118, GermanyTel +49 6221 5636388Fax +49 6221 5629213Email julian.doll@med.uni-heidelberg.dePurpose: Muscle, bone and tendon regeneration depend on the microperfusion of the corresponding tissue which can be quantified with contrast-enhanced ultrasound (CEUS) using sulfur hexafluoride contrast agent (SonoVue®). This study investigated the incidence of adverse events (AEs) in musculoskeletal patients and gives an overview of musculoskeletal CEUS applications.Patients and Methods: Based on 13 studies in a standardized monocentric setting, a total of 2268 CEUS examinations in 764 patients were performed and AEs due to the administration of sulfur hexafluoride contrast agent were classified as either mild, moderate or severe.Results: No fatal events occurred. AEs were reported in three cases, of which only one was classified as severe and two as mild. The total rate of all AEs was 0.13% and 0.04% for severe AEs.Conclusion: The present analysis confirms the safety of musculoskeletal CEUS using sulfur hexafluoride contrast agent with a lower rate of AEs than that reported for other contrast agents even in elderly patients with concomitant diseases.Keywords: contrast-enhanced ultrasound, CEUS, sulfur hexafluoride, musculoskeletal, contrast agents, adverse event