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Concierge contrast ultrasound · London

Microbubble testing, contrast-enhanced ultrasound with microbubble tracers for liver, kidney, cardiac and vascular imaging.

Microbubble ultrasound contrast (SonoVue) enables real-time, radiation-free vascular imaging in cardiology, hepatology, nephrology and vascular medicine. Characterises liver and renal lesions, LV opacification and endoleak surveillance.

Read the key facts
A consultant performing contrast-enhanced ultrasound with microbubble tracer in a private London clinic

Key facts

Microbubble testing at a glance.

Six things to know about contrast-enhanced ultrasound before you read the rest of the guide.

  • 01

    Definition

    Contrast-enhanced ultrasound with an intravenous microbubble tracer that reflects sound waves back to the probe.

  • 02

    Approved agents

    SonoVue, Definity and Optison — the three microbubble contrast agents licensed for clinical use.

  • 03

    No radiation

    Purely ultrasound-based, so there is no ionising radiation and no iodinated contrast.

  • 04

    Safe in renal impairment

    Microbubbles are exhaled through the lungs, not renally cleared — usable when CT contrast is contraindicated.

  • 05

    Liver and renal lesion characterisation

    Excellent at distinguishing benign from malignant focal liver and kidney lesions in real time.

  • 06

    Enhances echocardiogram borders

    Improves left-ventricular border definition when standard echo images are technically limited.

How it works

From consultation to structured report — what happens, in order.

Seven steps, one consultant, and a written report the same day.

  1. 01

    Before

    Consultation and referral

    A short discussion with the reporting consultant to confirm indication, contraindications and the specific clinical question.

  2. 02

    Before

    IV cannula inserted

    A small peripheral cannula, usually in the antecubital fossa, is placed for the contrast injection.

  3. 03

    On the day

    Baseline ultrasound

    Standard, non-contrast ultrasound images are acquired first to identify and localise the target lesion or chamber.

  4. 04

    On the day

    Contrast microbubbles injected

    A small bolus of SonoVue (or equivalent) is injected via the cannula and flushed with saline.

  5. 05

    On the day

    Real-time enhancement observed

    The consultant watches arterial, portal-venous and late phases live on the screen as the microbubbles perfuse the tissue.

  6. 06

    On the day

    Multiple sequences recorded

    Cine loops of each vascular phase are stored for the report and for any onward multidisciplinary review.

  7. 07

    After

    Structured report

    A written report with images is issued the same day, with onward MDT or specialty referral if the finding warrants it.

What it shows

When microbubble testing is the right test.

CEUS answers a specific question — is this tissue perfused, and how — across liver, kidney, heart and vascular grafts. These are the presentations we see most.

  • Liver lesion characterisation

    Distinguishes HCC, haemangioma and focal nodular hyperplasia by enhancement pattern.

  • Renal mass characterisation

    Separates complex cysts from solid renal masses when CT or MRI is inconclusive.

  • LV opacification (echocardiography)

    Improves left-ventricular border definition and detects apical thrombus on echo.

  • Endoleak detection post-EVAR

    Sensitive, radiation-free surveillance for endoleak after endovascular aneurysm repair.

  • Focal splenic lesion

    Characterises indeterminate splenic lesions found on prior CT or ultrasound.

  • Right-to-left shunt (bubble study)

    Agitated-saline bubble study to detect patent foramen ovale and intrapulmonary shunts.

  • Testicular / scrotal lesion

    Assesses vascularity of indeterminate testicular and scrotal lesions on greyscale ultrasound.

  • Red flag: HCC in a cirrhotic liver — MDT hepatology pathway

    A CEUS pattern typical of HCC in cirrhosis routes straight to a hepatology MDT.

Next steps

What happens after a microbubble study.

The onward pathway depends on what CEUS actually finds — from reassurance to an MDT referral.

  • Reassurance for a benign lesion

    A typical benign CEUS pattern (haemangioma, FNH, simple cyst) often needs no further imaging.

  • MRI for further characterisation

    Multiparametric MRI when CEUS features are equivocal or a full anatomical map is required.

  • CT-guided biopsy

    Percutaneous biopsy of an indeterminate solid lesion for histological diagnosis.

  • HCC MDT

    Referral to a hepatocellular carcinoma multidisciplinary team for staging and treatment planning.

  • Post-EVAR intervention

    Onward vascular-surgery review for endoleak repair when CEUS confirms a persistent leak.

  • Cardiology follow-up

    Structured cardiology review after LV opacification, bubble study or contrast echocardiography findings.

  • Renal cyst surveillance

    Interval CEUS or MRI surveillance for Bosniak II–III complex renal cysts.

  • Structured hepatology / vascular follow-up

    A defined follow-up interval and pathway back to the referring specialty team.

Red flags and contraindications

When microbubble contrast needs extra care.

CEUS is very safe, but a small set of situations either contraindicate contrast or route straight to a specialty team.

  • Anaphylaxis to microbubble contrast

    A previous severe allergic reaction to SonoVue, Definity or Optison is an absolute contraindication.

  • Right-to-left shunt

    A known significant right-to-left cardiac shunt requires careful risk assessment before contrast injection.

  • Recent acute coronary syndrome

    Unstable ischaemic symptoms within the last 7 days warrant caution and cardiology input.

  • Severe pulmonary hypertension

    Severe pulmonary hypertension (>90 mmHg) is a relative contraindication to microbubble contrast.

  • Pregnancy (relative)

    Microbubble contrast is generally avoided in pregnancy unless the clinical benefit clearly outweighs the theoretical risk.

  • Hepatocellular carcinoma

    A CEUS pattern typical of HCC — especially in cirrhosis — is an urgent hepatology MDT referral.

  • Renal mass

    A solid, enhancing renal mass on CEUS is a urology referral for onward staging.

  • Post-EVAR endoleak

    A persistent endoleak on surveillance CEUS is a vascular-surgery referral.

  • Cardiac tumour / thrombus

    An intracardiac mass or thrombus seen on contrast echo is an urgent cardiology referral.

Frequently asked

Everything we get asked about microbubble testing.

Quick answers on safety, kidney disease, liver characterisation, echocardiography and how CEUS differs from standard ultrasound.

  • What is microbubble testing?

    Microbubble testing is contrast-enhanced ultrasound (CEUS). A small volume of gas-filled microbubbles is injected into a vein and the microbubbles reflect ultrasound waves back to the probe, producing a real-time map of blood flow through the liver, kidneys, heart or vascular graft being studied.

  • Is microbubble contrast safe in kidney disease?

    Yes. Unlike CT iodinated contrast and MRI gadolinium, microbubbles are cleared through the lungs rather than the kidneys, so CEUS is safe when renal function is impaired and there is no risk of contrast-induced nephropathy.

  • What does microbubble ultrasound show in the liver?

    CEUS characterises focal liver lesions in real time — the classic enhancement pattern distinguishes hepatocellular carcinoma, haemangioma and focal nodular hyperplasia, and is particularly valuable in a cirrhotic liver where a typical HCC pattern is diagnostic.

  • Why is microbubble contrast used in echocardiography?

    When standard echo images are technically limited — often in patients with a difficult acoustic window — microbubble contrast sharply improves left-ventricular border definition, unmasks apical thrombus and clarifies wall-motion abnormalities.

  • Are there side effects from SonoVue?

    Serious reactions to SonoVue are rare. Most patients feel nothing at all. Mild, transient effects such as a brief headache or altered taste occur in a small minority; anaphylaxis is very uncommon but is the reason contrast is given only where full resuscitation facilities are available.

  • How is microbubble testing different from a standard ultrasound?

    A standard ultrasound shows anatomy and greyscale flow. Microbubble contrast adds a real-time vascular map — you see arterial, portal-venous and late enhancement phases dynamically, which is what allows lesion characterisation and endoleak detection that greyscale alone cannot provide.

Sources

Clinical guidelines behind this page.

Reviewed against the current EFSUMB, BSE, ESR and ACR guidance on contrast-enhanced ultrasound.

Last reviewed 2026-07-30. Next scheduled review 2027-07-30. Reading time ~6 minutes.

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In practice, in London

Getting microbubble testing sorted in London, without the guesswork

With microbubble testing, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. On the NHS, microbubble testing typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to — and it’s the single most common reason people call us in the first place.

In practice, a private microbubble testing appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For microbubble testing specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.

The value of going through a concierge for microbubble testing isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.

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