Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2012

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.

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

“…Finally, patients with chronic hepatitis, hepatic cirrhosis or severe fatty liver will make liver lesions difficult to detect on conventional ultrasound. [35][36][37][38] In the current study, pre-treatment conventional ultrasound showed that inconspicuous lesions accounted for 64.3% of all the lesions confirmed by CECT/CEMRI, thus conventional ultrasound-guided RFA is not suitable for them. Instead, guidance by other imaging modalities or referral to other treatment methods had to be carried out.…”

Developments in the application of high resolution ultrasound in clinical diagnostics

“…CEUS provides a technique with superb sensitivity from early arterial phase up to late venous enhancement in dynamic realtime vascular imaging. For the first time, this ultrasound technology allows the non-invasive demonstration of blood flow of inner organs at a microcirculatory level [1,2]. Further, the purely intravascular microbubbles enable ultrasound to be used to monitor changes in the blood flow of tumors and in inflamed areas in a diagnostic approach but also for therapy control.…”

“…Further, the purely intravascular microbubbles enable ultrasound to be used to monitor changes in the blood flow of tumors and in inflamed areas in a diagnostic approach but also for therapy control. Its performance without any requirement for ionizing radiation and with no nephrotoxicity makes it a compelling choice in many clinical arenas and is now FDA approved for liver imaging, and also for children [1][2][3][4][5][6][7][8].…”

“…For both applications guidelines already exist [1,[9][10][11] and it can be anticipated that additional guidelines will be forthcoming as CEUS and elastography technology evolve and more clinical studies and new applications are developed.…”

“…Further, the purely intravascular microbubbles enable ultrasound to be used to monitor changes in the blood flow of tumors and in inflamed areas in a diagnostic approach but also for therapy control. Its performance without any requirement for ionizing radiation and with no nephrotoxicity makes it a compelling choice in many clinical arenas and is now FDA approved for liver imaging, and also for children [1][2][3][4][5][6][7][8].In this special issue, a first study evaluated factors which are associated with the initial incomplete ablation in radiofrequency ablation (RFA) for thyroid nodules [2]. Recent intraoperative studies reported the results of CEUS for immediate assessment of ablation status after RFA of hepatic malignancies [3].…”