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Volume quantification by contrast-enhanced ultrasound: an in-vitro comparison with true volumes and thermodilution

Ingeborg HF Herold1*, Gianna Russo2, Massimo Mischi2, Patrick Houthuizen3, Tamerlan Saidov2, Marcel van het Veer3, Hans C van Assen2 and Hendrikus HM Korsten12

Author Affiliations

1 Department of Anesthesia and Intensive Care, Catharina hospital Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands

2 Department of Electrical Engineering, Eindhoven University of Technology, Den Dolech 2, Eindhoven 5612 AZ, The Netherlands

3 Department of Cardiology, Catharina hospital Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands

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Cardiovascular Ultrasound 2013, 11:36  doi:10.1186/1476-7120-11-36

Published: 17 October 2013



Contrast-enhanced ultrasound (CEUS) has recently been proposed as a minimally- invasive, alternative method for blood volume measurement. This study aims at comparing the accuracy of CEUS and the classical thermodilution techniques for volume assessment in an in-vitro set-up.


The in-vitro set-up consisted of a variable network between an inflow and outflow tube and a roller pump. The inflow and outflow tubes were insonified with an ultrasound array transducer and a thermistor was placed in each tube. Indicator dilution curves were made by injecting indicator which consisted of an ultrasound-contrast-agent diluted in ice-cold saline. Both acoustic intensity- and thermo-dilution curves were used to calculate the indicator mean transit time between the inflow and outflow tube. The volumes were derived by multiplying the estimated mean transit time by the flow rate. We compared the volumes measured by CEUS with the true volumes of the variable network and those measured by thermodilution by Bland-Altman and intraclass-correlation analysis.


The measurements by CEUS and thermodilution showed a very strong correlation (rs = 0.94) with a modest volume underestimation by CEUS of −40 ± 28 mL and an overestimation of 84 ± 62 mL by thermodilution compared with the true volumes. Both CEUS and thermodilution showed a high statistically significant correlation with the true volume (rs = 0.97 (95% CI, 0.95 - 0.98; P<0.0001) and rs = 0.96 (95% CI, 0.94 - 0.98; P<0.0001, respectively).


CEUS volume estimation provides a strong correlation with both the true volumes in-vitro and volume estimation by thermodilution. It may therefore represent an interesting alternative to the standard, invasive thermodilution technique.

Contrast-enhanced ultrasound; Thermodilution; Blood volume; Indicator-dilution curve