{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T04:34:01Z","timestamp":1792557241595,"version":"4.5.0"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis are aimed at evaluating the incidence of adverse drug reactions (ADRs) following administration of clinically approved ultrasound contrast agents (UCAs) in adults and children, to assess risks in patients with cardiovascular disease and in pregnancy, and to evaluate the effectiveness of emergency management of severe ADRs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A PRISMA 2020 systematic review was conducted searching PubMed, Scopus, and Embase. Two reviewers independently screened, extracted data, and assessed quality. Incidence estimates were pooled when feasible, stratified by age group, contrast agent, and administration route.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy-four studies encompassing &gt;\u20091 million adults and &gt;\u200936,000 children were included, contributing multiple analytic cohorts to the quantitative synthesis. Severe acute ADRs were extremely rare (6 and 16 cases per 100,000 in adults and children, respectively) and absent following endocavitary administration in children. Non-severe acute ADRs occurred in 11 and 8 cases per 10,000 adults and children, respectively. Delayed reactions were very rare (&lt;\u20091 case per million in adults). No significant safety differences emerged between UCA products. The incidence of ADRs in patients with cardiovascular disease was analogous to the general population. No ADRs were reported in pregnant women. Standard emergency management was effective in almost all serious cases, though rare fatalities occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>UCAs show an excellent safety profile in adults and children, with very rare severe ADRs and few non-severe, typically self-limiting reactions. Strict adherence to recommended emergency management protocols mitigates the remaining risks, supporting safe use across a broad range of clinical indications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration<\/jats:title>\n                    <jats:p>CRD42023432668.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>What is the incidence, type, and severity of acute and delayed ADRs associated with clinically approved UCAs across different patient populations<\/jats:italic>\n                      ?\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Severe acute adverse reactions are very rare, and non-severe reactions are rare and self-limiting, with no significant safety differences between adults, children, or patients with cardiovascular disease<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevant<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>UCAs show an excellent safety profile across populations. These findings support their safe clinical use as reliable alternatives to iodine-based and gadolinium-based contrast agents in routine diagnostic imaging<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12594-5","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T19:22:02Z","timestamp":1778872922000},"page":"7671-7683","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Type, severity, frequency and management of adverse reactions associated with ultrasound contrast agents: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"36","author":[{"given":"Honoria","family":"Ocagli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Romanini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adea","family":"Llane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"di Nola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aart J.","family":"van der Molen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-France","family":"Bellin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torkel","family":"Brismar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Correas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Deike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilona A.","family":"Dekkers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remy W. F.","family":"Geenen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertraud","family":"Heinz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas H.","family":"Mahnken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo A.","family":"Mallio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo C.","family":"Quattrocchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Radbruch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Reimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giles","family":"Roditi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Sebasti\u00e0","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Cl\u00e9ment","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Gregori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5583-350X","authenticated-orcid":false,"given":"Michele","family":"Bertolotto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"12594_CR1","doi-asserted-by":"publisher","first-page":"S338","DOI":"10.1007\/PL00014069","volume":"9","author":"L Dalla Palma","year":"1999","unstructured":"Dalla Palma L, Bertolotto M (1999) Introduction to ultrasound contrast agents: physics overview. Eur Radiol 9:S338\u2013S342","journal-title":"Eur Radiol"},{"key":"12594_CR2","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1007\/s00247-021-05080-1","volume":"51","author":"A Sridharan","year":"2021","unstructured":"Sridharan A, Eisenbrey JR, Forsberg F et al (2021) Ultrasound contrast agents: microbubbles made simple for the pediatric radiologist. Pediatr Radiol 51:2117\u20132127","journal-title":"Pediatr Radiol"},{"key":"12594_CR3","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.echo.2017.11.013","volume":"31","author":"TR Porter","year":"2018","unstructured":"Porter TR, Mulvagh SL, Abdelmoneim SS et al (2018) Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr 31:241\u2013274","journal-title":"J Am Soc Echocardiogr"},{"key":"12594_CR4","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1055\/a-1177-0530","volume":"41","author":"CF Dietrich","year":"2020","unstructured":"Dietrich CF, Nols\u00f8e CP, Barr RG et al (2020) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver\u2014update 2020\u2014WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultraschall Med Biol 41:562\u2013585","journal-title":"Ultraschall Med Biol"},{"key":"12594_CR5","first-page":"e2","volume":"1980","author":"PS Sidhu","year":"2018","unstructured":"Sidhu PS, Cantisani V, Dietrich CF et al (2018) The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version). Ultraschall Med Stuttg Ger 1980:e2\u2013e44","journal-title":"Ultraschall Med Stuttg Ger"},{"key":"12594_CR6","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.jacc.2008.08.066","volume":"53","author":"MS Dolan","year":"2009","unstructured":"Dolan MS, Gala SS, Dodla S et al (2009) Safety and efficacy of commercially available ultrasound contrast agents for rest and stress echocardiography: a multicenter experience. J Am Coll Cardiol 53:32\u201338","journal-title":"J Am Coll Cardiol"},{"key":"12594_CR7","doi-asserted-by":"publisher","first-page":"e17745","DOI":"10.1097\/MD.0000000000017745","volume":"98","author":"C Hu","year":"2019","unstructured":"Hu C, Feng Y, Huang P, Jin J (2019) Adverse reactions after the use of SonoVue contrast agent: characteristics and nursing care experience. Med Baltim 98:e17745","journal-title":"Med Baltim"},{"key":"12594_CR8","doi-asserted-by":"publisher","unstructured":"Li Q, Yang K, Ji Y et al (2022) Safety analysis of adverse events of ultrasound contrast agent lumason\/SonoVue in 49,100 patients. Ultrasound Med Biol. https:\/\/doi.org\/10.1016\/j.ultrasmedbio.2022.09.014","DOI":"10.1016\/j.ultrasmedbio.2022.09.014"},{"key":"12594_CR9","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1016\/j.ultrasmedbio.2006.05.031","volume":"32","author":"F Piscaglia","year":"2006","unstructured":"Piscaglia F, Bolondi L, Aiani L et al (2006) The safety of Sonovue\u00ae in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 32:1369\u20131375","journal-title":"Ultrasound Med Biol"},{"key":"12594_CR10","doi-asserted-by":"publisher","first-page":"531","DOI":"10.7863\/ultra.15.11075","volume":"36","author":"C Tang","year":"2017","unstructured":"Tang C, Fang K, Guo Y et al (2017) Safety of sulfur hexafluoride microbubbles in sonography of abdominal and superficial organs: retrospective analysis of 30,222 cases. J Ultrasound Med 36:531\u2013538","journal-title":"J Ultrasound Med"},{"key":"12594_CR11","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1016\/j.echo.2008.07.019","volume":"21","author":"K Wei","year":"2008","unstructured":"Wei K, Mulvagh SL, Carson L et al (2008) The safety of deFinity and Optison for ultrasound image enhancement: a retrospective analysis of 78,383 administered contrast doses. J Am Soc Echocardiogr 21:1202\u20131206","journal-title":"J Am Soc Echocardiogr"},{"key":"12594_CR12","doi-asserted-by":"publisher","first-page":"10","DOI":"10.4329\/wjr.v9.i1.10","volume":"9","author":"R Girometti","year":"2017","unstructured":"Girometti R, Stocca T, Serena E et al (2017) Impact of contrast-enhanced ultrasound in patients with renal function impairment. World J Radiol 9:10\u201316","journal-title":"World J Radiol"},{"key":"12594_CR13","unstructured":"European Medicines Agency (EMA) (2003) ICH E2D post-approval safety data management\u2014scientific guideline. https:\/\/www.ema.europa.eu\/en\/ich-e2d-post-approval-safety-data-management-scientific-guideline. Accessed 2 Nov 2025"},{"key":"12594_CR14","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71","journal-title":"BMJ"},{"key":"12594_CR15","doi-asserted-by":"publisher","unstructured":"van der Molen AJ, van de Ven AAJM, Vega F et al (2025) Hypersensitivity reactions to contrast media: part 1. Management of immediate and non-immediate hypersensitivity reactions in adults. Updated guidelines by the ESUR Contrast Media Safety Committee. Eur Radiol. https:\/\/doi.org\/10.1007\/s00330-025-11675-1","DOI":"10.1007\/s00330-025-11675-1"},{"key":"12594_CR16","doi-asserted-by":"publisher","first-page":"112355","DOI":"10.1016\/j.ejrad.2025.112355","volume":"191","author":"AJ Van Der Molen","year":"2025","unstructured":"Van Der Molen AJ, Vega F (2025) Acute non-hypersensitivity adverse reactions following intravascular administration of contrast agents in adult patients. Eur J Radiol 191:112355","journal-title":"Eur J Radiol"},{"key":"12594_CR17","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1007\/s40801-025-00492-z","volume":"12","author":"MRA Lirasan","year":"2025","unstructured":"Lirasan MRA, Adamson MHB, Cruz VG et al (2025) Understanding underreporting of adverse drug reactions in the Philippines: a mixed methods study. Drugs Real World Outcomes 12:367\u2013381","journal-title":"Drugs Real World Outcomes"},{"key":"12594_CR18","unstructured":"European Commission (2009) A guideline on summary of product characteristics (SmPC). Revision 2. September 2009. In: EudraLex\u2014Volume 2 C, notice to applicants. European Commission, Brussels. https:\/\/health.ec.europa.eu\/medicinal-products\/eudralex\/eudralex-volume-2_en. Accessed 2 Nov 2025"},{"key":"12594_CR19","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1097\/XEB.0000000000000054","volume":"13","author":"Z Munn","year":"2015","unstructured":"Munn Z, Moola S, Lisy K et al (2015) Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and incidence data. Int J Evid Based Healthc 13:147\u2013153","journal-title":"Int J Evid Based Healthc"},{"key":"12594_CR20","unstructured":"Moola S, Munn Z, Tufanaru C et al (2017) Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (eds) Joanna Briggs Institute Reviewer\u2019s Manual. The Joanna Briggs Institute"},{"key":"12594_CR21","unstructured":"Tufanaru C, Munn Z, Aromataris E et al (2017) Systematic reviews of effectiveness. In: Aromataris E, Munn Z (eds) Joanna Briggs Institute Reviewer\u2019s manual, Ch p. The Joanna Briggs Institute"},{"key":"12594_CR22","doi-asserted-by":"crossref","unstructured":"Borenstein M, Hedges LV, Higgins JP, Rothstein HR (2021) Introduction to meta-analysis. John Wiley & Sons","DOI":"10.1002\/9781119558378"},{"key":"12594_CR23","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","volume":"21","author":"JPT Higgins","year":"2002","unstructured":"Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539\u20131558","journal-title":"Stat Med"},{"key":"12594_CR24","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s43441-021-00353-1","volume":"56","author":"A Chakraborty","year":"2022","unstructured":"Chakraborty A, Xu J, Tiwari R (2022) Zero-inflated binomial model for meta-analysis and safety-signal detection. Ther Innov Regul Sci 56:255\u2013262","journal-title":"Ther Innov Regul Sci"},{"key":"12594_CR25","unstructured":"Team RC (2016) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna"},{"key":"12594_CR26","doi-asserted-by":"publisher","first-page":"W400","DOI":"10.2214\/AJR.12.10518","volume":"202","author":"Y Miyamoto","year":"2014","unstructured":"Miyamoto Y, Ito T, Takada E et al (2014) Efficacy of sonazoid (perflubutane) for contrast-enhanced ultrasound in the differentiation of focal breast lesions: phase 3 multicenter clinical trial. AJR Am J Roentgenol 202:W400\u2013W407","journal-title":"AJR Am J Roentgenol"},{"key":"12594_CR27","doi-asserted-by":"publisher","first-page":"102612","DOI":"10.1016\/j.jaccas.2024.102612","volume":"29","author":"E Marchi","year":"2024","unstructured":"Marchi E, Sciara P, Casini M et al (2024) Subacute stent thrombosis related to Kounis syndrome during anaphylaxis induced by ultrasound contrast agent infusion. JACC Case Rep 29:102612","journal-title":"JACC Case Rep"},{"key":"12594_CR28","doi-asserted-by":"publisher","unstructured":"Nomigolzar S, Khederzadeh S, Baggett A et al (2022) Type I Kounis syndrome induced by echocardiography contrast agent sulfur hexafluoride. Circulation. https:\/\/doi.org\/10.1161\/circ.146.suppl_1.10046","DOI":"10.1161\/circ.146.suppl_1.10046"},{"key":"12594_CR29","doi-asserted-by":"publisher","first-page":"757EP","DOI":"10.1016\/j.cjco.2023.07.009","volume":"5","author":"A Sagalov","year":"2023","unstructured":"Sagalov A, Eggert A, Rimawi A, Hegde S (2023) A rare presentation of kounis syndrome induced by an echocardiography contrast. CJC Open 5:757EP\u2013759EP","journal-title":"CJC Open"},{"key":"12594_CR30","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s12471-013-0440-9","volume":"22","author":"AG van Ginkel","year":"2014","unstructured":"van Ginkel AG, Sorgdrager BJ, de Graaf MA et al (2014) ST-segment elevation associated with allergic reaction to echocardiographic contrast agent administration. Neth Heart J 22:77\u201379","journal-title":"Neth Heart J"},{"key":"12594_CR31","doi-asserted-by":"publisher","unstructured":"Steinhauer R, Miyashita S, Maslon L et al (2022) A rare case of echo contrast anaphylaxis complicated by acute coronary syndrome. Circulation. https:\/\/doi.org\/10.1161\/circ.146.suppl_1.11227","DOI":"10.1161\/circ.146.suppl_1.11227"},{"key":"12594_CR32","doi-asserted-by":"publisher","unstructured":"Arnouk S, Huynh Q, Saric M, Papadopoulos J (2023) A case report of cardiac arrest after intravenous administration of sulfur hexafluoride (Lumason(\u00ae)) ultrasound enhancing agent. J Pharm Pr. https:\/\/doi.org\/10.1177\/08971900231158935","DOI":"10.1177\/08971900231158935"},{"key":"12594_CR33","doi-asserted-by":"publisher","first-page":"753.e5","DOI":"10.1016\/j.echo.2009.01.025","volume":"22","author":"H Mahjoub","year":"2009","unstructured":"Mahjoub H, Rom\u00e9o P, Leung T-K et al (2009) Sudden death after intravenous administration of a perflutren contrast agent: A case of pseudocomplication? J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr 22:753.e5\u20138","journal-title":"J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr"},{"key":"12594_CR34","first-page":"384","volume":"42","author":"S Coudray","year":"2017","unstructured":"Coudray S, Fabre C, Aichoun I, Perez-Martin A (2017) Anaphylactic shock with an ultrasound contrast agent. J Med Vasc 42:384\u2013387","journal-title":"J Med Vasc"},{"key":"12594_CR35","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1016\/j.anai.2011.12.011","volume":"108","author":"JA Levano","year":"2012","unstructured":"Levano JA, Jimenez MA, Laiseca A, Vives R (2012) Anaphylactic shock due to SonoVue. Ann Allergy Asthma Immunol 108:208\u2013209","journal-title":"Ann Allergy Asthma Immunol"},{"key":"12594_CR36","doi-asserted-by":"publisher","unstructured":"Longhino D, Buonomo A, Zocco MA et al (2024) Anaphylaxis after SonoVue: a case report and a literature review. J Clin Med. https:\/\/doi.org\/10.3390\/jcm13175018","DOI":"10.3390\/jcm13175018"},{"key":"12594_CR37","doi-asserted-by":"publisher","first-page":"S112","DOI":"10.1016\/j.anai.2024.08.485","volume":"133","author":"A Minc","year":"2024","unstructured":"Minc A, Baldwin J, Kolias T, LaBounty T (2024) A case of anaphylaxis to cardiac ultrasound enhancing agent. Ann Allergy Asthma Immunol 133:S112","journal-title":"Ann Allergy Asthma Immunol"},{"key":"12594_CR38","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1016\/j.jaip.2019.12.041","volume":"8","author":"MS Krantz","year":"2020","unstructured":"Krantz MS, Liu Y, Phillips EJ, Stone CA (2020) Anaphylaxis to PEGylated liposomal echocardiogram contrast in a patient with IgE-mediated macrogol allergy. J Allergy Clin Immunol Pract 8:1416\u20131419.e3","journal-title":"J Allergy Clin Immunol Pract"},{"key":"12594_CR39","doi-asserted-by":"publisher","unstructured":"Nigolian A, Nigolian H, Harr T, Cook S (2024) Anaphylactic shock and cardiac arrest after intravenous injection of sulphur hexafluoride SonoVue. BMJ Case Rep. https:\/\/doi.org\/10.1136\/bcr-2024-262018","DOI":"10.1136\/bcr-2024-262018"},{"key":"12594_CR40","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1002\/jcu.22585","volume":"46","author":"MC Olson","year":"2018","unstructured":"Olson MC, Atwell TD, Knudsen JM (2018) Anaphylactic reaction to an ultrasound contrast agent (Lumason) in a patient with systemic mastocytosis. J Clin Ultrasound 46:533\u2013535","journal-title":"J Clin Ultrasound"},{"key":"12594_CR41","doi-asserted-by":"publisher","first-page":"1225654","DOI":"10.3389\/fcvm.2023.1225654","volume":"10","author":"A Filippone","year":"2023","unstructured":"Filippone A, Kirchin MA, Monteith J et al (2023) Safety of Lumason\u00ae (SonoVue\u00ae) in special populations and critically ill patients. Front Cardiovasc Med 10:1225654","journal-title":"Front Cardiovasc Med"},{"key":"12594_CR42","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1055\/a-2351-0747","volume":"46","author":"S Dassen","year":"2025","unstructured":"Dassen S, Monen L, Oei G et al (2025) Safety of contrast-enhanced ultrasound using microbubbles in human pregnancy: a scoping review. Ultraschall Med 46:259\u2013269","journal-title":"Ultraschall Med"},{"key":"12594_CR43","doi-asserted-by":"publisher","first-page":"e039480","DOI":"10.1161\/JAHA.124.039480","volume":"14","author":"JB Strom","year":"2025","unstructured":"Strom JB, Mulvagh SL, Porter TR et al (2025) Contemporary safety of ultrasound enhancing agents in a nationwide analysis. J Am Heart Assoc 14:e039480","journal-title":"J Am Heart Assoc"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12594-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-026-12594-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12594-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:53:20Z","timestamp":1789379600000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-026-12594-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":43,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["12594"],"URL":"https:\/\/doi.org\/10.1007\/s00330-026-12594-5","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]},"assertion":[{"value":"10 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The scientific guarantor of this publication is Michele Bertolotto.","order":1,"name":"Ethics","label":"Guarantor","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"T.B. is a member of the scientific editorial board of European Radiology and, as such, did not participate in the selection or review processes for this article. A.L. is affiliated with Epistudia. The remaining authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Honoria Ocagli, Dario Gregori, Adea Llane, and Stefano di Nola have significant statistical expertise.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was not required for this study because it is a systematic review of published investigations.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was not required because this study is a systematic review.","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"There is no subjects or cohorts overlap.","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}