The past decade has been witness to the often stumbling growth in the use of microbubble contrast agents for ultrasound. In spite of initial concerns for the safety of these bubbles, today CEUS is established for the noninvasive characterization of focal liver masses. Other indications with variable acceptance include monitoring of radiofrequency ablation (RFA) of liver tumors, surveillance of aortic stent grafts, superb characterization of cystic neoplasms in the kidney, and characterization and improved detection of focal masses in virtually all of the solid abdominal and pelvic viscera. Used as a measure of blood flow, CEUS of the bowel shows correlation with disease activity when performed on thickened bowel in patients with Crohn's disease.

The liver will undoubtedly remain the major focus for CEUS. Specific hepatic indications include the accurate diagnosis of incidentally detected liver masses, sensitive detection of live metastases and an invaluable role in the diagnosis of small nodules in the patient with cirrhosis. CEUS also serves to resolve indeterminate lesions shown on either CT or MR scan.

After a somewhat stormy introduction to the clinical market, the safety of microbubble contrast agents seems to be accepted today. Lack of reimbursement in many jurisdictions and lack of a radiology approval by the Federal Drug Agency (FDA) in the United States both continue to plague the overall international growth and success of this exciting and effective method of contrast enhanced imaging. However, its great success without the requirement for ionizing radiation seems a predictor for a successful future.