The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications
University of Bologna1, University of Copenhagen2, Imperial College London3, University of Bergen4, University of Trieste5, Ludwig Maximilian University of Munich6, University of Paris7, University of Verona8, Sapienza University of Rome9, University of Regensburg10, Innsbruck Medical University11, Institut Gustave Roussy12, Hai phong University Of Medicine and Pharmacy13, University of Cambridge14, The Royal Marsden NHS Foundation Trust15, Katholieke Universiteit Leuven16
26 Aug 2011-Ultraschall in Der Medizin (© Georg Thieme Verlag KG Stuttgart · New York)-Vol. 33, Iss: 1, pp 33-59
TL;DR: Authors F. Piscaglia, C. Nolsøe, M. M. Gilja, and H. P. Weskott review the manuscript and suggest ways in which the manuscript could have been improved.
Abstract: Authors F. Piscaglia1, C. Nolsøe2, C. F. Dietrich3, D. O. Cosgrove4, O. H. Gilja5, M. Bachmann Nielsen6, T. Albrecht7, L. Barozzi8, M. Bertolotto9, O. Catalano10, M. Claudon11, D. A. Clevert12, J. M. Correas13, M. D’Onofrio14, F. M. Drudi15, J. Eyding16, M. Giovannini17, M. Hocke18, A. Ignee19, E. M. Jung20, A. S. Klauser21, N. Lassau22, E. Leen23, G. Mathis24, A. Saftoiu25, G. Seidel26, P. S. Sidhu27, G. ter. Haar28, D. Timmerman29, H. P. Weskott30
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Seoul National University1, Hammersmith Hospital2, Kindai University3, University of Copenhagen4, University of Bologna5, University of Calgary6, Northeast Ohio Medical University7, University of São Paulo8, Jaslok Hospital9, Peking Union Medical College10, Ludwig Maximilian University of Munich11, University of Paris12, Fudan University13, Thomas Jefferson University14, University of Michigan15, University of Melbourne16, Institut Gustave Roussy17, Imperial College London18, University of California, San Diego19, Tokyo Medical University20, Tongji University21
TL;DR: These liver CEUS guidelines and recommendations are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.
Abstract: Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.
1,042 citations
Goethe University Frankfurt1, University of Pavia2, Policlinico Umberto I3, Paris Descartes University4, University of Verona5, École Normale Supérieure6, University of Bergen7, Haukeland University Hospital8, Innsbruck Medical University9, University of Medicine and Pharmacy of Craiova10, University of Bologna11
TL;DR: The technical part of these Guidelines and Recommendations provides an introduction to the physical principles and technology on which all forms of current commercially available ultrasound elastography are based.
Abstract: The technical part of these Guidelines and Recommendations, produced under the auspices of EFSUMB, provides an introduction to the physical principles and technology on which all forms of current commercially available ultrasound elastography are based. A difference in shear modulus is the common underlying physical mechanism that provides tissue contrast in all elastograms. The relationship between the alternative technologies is considered in terms of the method used to take advantage of this. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided on optimisation of scanning technique, image display, image interpretation and some of the known image artefacts.
1,020 citations
University of Bologna1, The Royal Marsden NHS Foundation Trust2, Goethe University Frankfurt3, Paris Descartes University4, University of Bergen5, Innsbruck Medical University6, University of Pavia7, Policlinico Umberto I8, University of Verona9, École Normale Supérieure10, Haukeland University Hospital11, University of Medicine and Pharmacy of Craiova12
TL;DR: The clinical part of these Guidelines and Recommendations produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology EFSUMB assesses the clinically used applications of all forms of elastography, stressing the evidence from meta-analyses and giving practical advice for their uses and interpretation.
Abstract: The clinical part of these Guidelines and Recommendations produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology EFSUMB assesses the clinically used applications of all forms of elastography, stressing the evidence from meta-analyses and giving practical advice for their uses and interpretation. Diffuse liver disease forms the largest section, reflecting the wide experience with transient and shear wave elastography . Then follow the breast, thyroid, gastro-intestinal tract, endoscopic elastography, the prostate and the musculo-skeletal system using strain and shear wave elastography as appropriate. The document is intended to form a reference and to guide clinical users in a practical way.
830 citations
King's College London1, Policlinico Umberto I2, Zhengzhou University3, University of Bergen4, University of Medicine and Pharmacy of Craiova5, University of Trieste6, University of Pavia7, Ludwig Maximilian University of Munich8, Imperial College London9, University of Verona10, Sapienza University of Rome11, Derriford Hospital12, University Hospital Regensburg13, University of Innsbruck14, Université Paris-Saclay15, University of Barcelona16, University of Copenhagen17, University of Bologna18, University of Virginia19, University of Vienna20, Eindhoven University of Technology21
TL;DR: The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.
Abstract: The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.
638 citations
Cites background or methods from "The EFSUMB Guidelines and Recommend..."
...Ultrasound equipment based on contrast-specific ultrasound modes is needed for CEUS examinations, based on the separation between non-linear response induced by microbubble UCA oscillations and linear US signal reflected by tissues [4]....
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...Two phases are described for most organs that have a single arterial blood supply (except the liver and lungs) [3, 4]: a) the arterial phase starts from around 10 –20 seconds until around 35 – 40 seconds after contrast injection, showing a progressive degree of enhancement; b) the venous phase starts from around 30 to 45 seconds after contrast injection, showing a plateau and then a progressive decrease....
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...Serious anaphylactoid reactions to UCAs are observed in approximately 1:10 000 exposures [4, 20]....
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...Ultrasound contrast agents are used for enhancement of the US signal from flowing blood as they are limited to the blood vessels (blood pool UCA) [3, 4]....
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...Enhancement begins immediately after aortic enhancement, with an arterial phase (10 to 30 s), a venous phase (30 to approximately 120 s) [2, 4]....
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University of Lorraine1, Seoul National University2, Hammersmith Hospital3, Kindai University4, University of Copenhagen5, University of Bologna6, University of Calgary7, Northeast Ohio Medical University8, University of São Paulo9, Jaslok Hospital10, Peking Union Medical College11, Ludwig Maximilian University of Munich12, University of Paris13, Fudan University14, Thomas Jefferson University15, University of Michigan16, University of Melbourne17, Institut Gustave Roussy18, Imperial College London19, University of California, San Diego20, Tokyo Medical University21, Tongji University22
TL;DR: These liver CEUS guidelines and recommendations are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.
Abstract: Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.
432 citations
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TL;DR: In vitro measurements comparing flowing agent and cellulose particles suggest that pulse inversion Doppler can provide 3 to 10 dB more agent to tissue contrast than harmonic imaging with similar pulses, and in vitro measurements suggest that broadband pulse inverts can provide up to 16 dB more contrast than broadband conventional Dopplers.
Abstract: A novel technique for the selective detection of ultrasound contrast agents, called pulse inversion Doppler, has been developed. In this technique, a conventional Doppler or color Doppler pulse sequence is modified by inverting every second transmit pulse. Either conventional or harmonic Doppler processing is then performed on the received echoes. In the resulting Doppler spectra, Doppler shifts from linear and nonlinear scattering are separated into two distinct regions that can be analyzed separately or combined to estimate the ratio of nonlinear to linear scattering from a region of tissue. The maximum Doppler shift that can be detected is 1/2 the normal Nyquist limit. This has the advantage over conventional harmonic Doppler that it can function over the entire bandwidth of the echo signal, thus achieving superior spatial resolution in the Doppler image. In vitro measurements comparing flowing agent and cellulose particles suggest that pulse inversion Doppler can provide 3 to 10 dB more agent to tissue contrast than harmonic imaging with similar pulses. Similar measurements suggest that broadband pulse inversion Doppler can provide up to 16 dB more contrast than broadband conventional Doppler. Nonlinear propagation effects limit the maximum contrast obtainable with both harmonic and pulse inversion Doppler techniques.
753 citations
TL;DR: The present large-scale retrospective analysis showed that SonoVue has a good safety profile in abdominal applications, with an AE reporting rate lower than or similar to that reported for radiologic and magnetic resonance contrast agents.
Abstract: The aim of the present retrospective study was to assess the incidence of adverse events (AE) of a second-generation ultrasound contrast agent in real clinical practice. A total of 28 Italian Centres provided data on the postmarketing use of SonoVue (Bracco Spa, Milan, Italy) in abdominal examination performed between December 2001 and December 2004. A total of 23 188 investigations were reported. No fatal event occurred. AEs were reported in 29 cases, of which only two were graded as serious; the rest, 27, were nonserious (23 mild, three moderate and one severe). The overall reporting rate of serious AE was 0.0086%. Overall, only four AEs required treatment (two serious, two nonserious including one moderate and one severe AEs). In conclusion, the present large-scale retrospective analysis showed that SonoVue has a good safety profile in abdominal applications, with an AE reporting rate lower than or similar to that reported for radiologic and magnetic resonance contrast agents.
632 citations