Safety of Sulfur Hexafluoride Microbubbles in Sonography of Abdominal and Superficial Organs: Retrospective Analysis of 30,222 Cases

Abstract

Contrast-enhanced sonography with sulfur hexafluoride microbubbles had good clinical safety, but rare adverse reactions were observed. A comprehensive emergency plan and rescue measures for adverse reactions should be prepared and made available to minimize the occurrence of negative clinical outcomes.

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version)

“…UCAs have a very low rate of anaphylactoid reactions (1:7000 patients, 0.014 %) [17,21,22], [20] significantly lower than the rate with iodinated state-of-the-art CT agents (35 -95:100 000 patients, 0.035 -0.095 %) [23], comparable to the rate of severe anaphylactoid reactions associated with gadolinium-based contrast agents at 0.001 -0.01 % [24]. Serious anaphylactoid reactions to UCAs are observed in approximately 1:10 000 exposures [4,20]. Data from 75 completed studies (pooled data from 6307 patients) in North America, Europe, and Asia showed that the most frequent adverse events were headache (2.1 %), nausea (0.9 %), chest pain (0.8 %) and chest discomfort (0.5 %).…”

<p>Safety Profile of Musculoskeletal Contrast-Enhanced Ultrasound with Sulfur Hexafluoride Contrast Agent</p>

“…1 In another study from 2017, Tang et al reported similar results on 30,222 cases, undergoing CEUS of abdominal (liver, gallbladder, pancreas, spleen, and kidney) and superficial (thyroid, breast, lymph nodes and prostate) organs with an overall incidence rate of severe AEs at 0.007%. 11 The adverse events, which were monitored in our study patients during or immediately following CEUS, have been similarly described in other studies and are included in the sulfur hexafluoride contrast agent product insert. Typical mild side effects, as described in the sulfur hexafluoride contrast agent product insert or in our and former studies, were also observed after controlled randomized intravenous injection of placebos, 4,28 including moderate hypotension, headache, discomfort, dizziness, nausea, vomiting, sensation of warmth and itching.…”

“…10 The average in vivo half-life of these microbubbles is 12 minutes (range, 2-33 minutes). 11 Sulfur hexafluoride contrast agent is not excreted by the kidneys. Therefore, it can be used in patients with renal dysfunction, when contrast agents for computed tomography (CT) or magnetic resonance imaging (MRI) are contraindicated.…”

Microbubble contrast-enhanced ultrasound in the vascular evaluation after pancreas transplantation: a single-center experience

“…It is not yet known if CEUS can safely monitor the natural course of a thrombus once detected. US contrast agents are admin-istered safely with minimal risk to patients (13). The contrast medium of CEUS is not excreted through the kidneys and can be safely administered to patients with renal insufficiency, attractive features after PTx (14).…”