An EFSUMB Introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for Quantification of Tumour Perfusion

Abstract

Dynamic Contrast Enhanced Ultrasound (DCE-US) is an imaging technique that utilizes microbubble contrast agents in diagnostic ultrasound. The EFSUMB guidelines published in 2004, updated in 2008 and 2011 focused on the use of DCE-US, including essential technical requirements, training, investigational procedures and steps, guidance on image interpretation, established and recommended clinical indications and safety considerations. However the quantification of images acquired with ultrasound contrast agents (UCAs) is not discussed in the guidelines. The purpose of this EFSUMB document is to provide some recommendations and descriptions of the quantification of ultrasound images, technical requirements for analysis of time-intensity curves (TICs), methodology for data analysis, and interpretation of the results.

Is contrast enhanced ultrasonography a useful tool for the evaluation of muscular microcirculation in patients with critical limb ischaemia?

“…In the 21 patients with comparative measurements, mean TcPO2 improved from 20 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) to 43 (27-56) mm Hg at one month (P = 0.007) and mean toe pressure from 32 to 54 mm Hg (P = 0.002) (Figure 2). …”

“…Nevertheless, comparison of values in a single patient in our study should have reduced this potential bias. The same method as in other recent studies was used [11] (use of Sonovue, bolus of 4.8 cc, analysis on raw data by software), which is in fact the reference method for the use of time intensity curves in parenchyma [8,23].…”

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“…The development of such a curve is complex however and there are several ways of modelling it [48]. Since the curve development is also profoundly affected by other factors such as injection speed, injection site and vascular architecture it does not compare very well to the local perfusion [50].…”

“…The development of the burst-replenishment curve is simpler to model [48]. Another advantage of such a technique is that repeated measurements are possible during the same injection reducing variability and/or enabling sampling from several imaging planes.…”

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“…The acronym CEUS refers to contrast-enhanced ultrasound techniques in general [1][2][3][4][5][6][7][8][9][10][11]. Dynamic contrast enhanced ultrasound (DCE-US) refers to quantitative time intensity curve (TIC) analysis [11][12][13] using either bolus injection of microbubbles [13][14][15][16] or intravenous infusion with disruption-replenishment technique [17] which are used for treatment response evaluation in oncology [18] and for activity assessment in inflammation of the bowel wall in inflammatory bowel disease [19][20][21][22].…”