Contrast-Enhanced Endoscopic Ultrasound

Abstract

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) introduced guidelines on the use of contrast-enhanced ultrasound (CEUS) in 2004. This EFSUMB-document focused mainly on liver applications. However, new applications extending beyond the liver were developed thereafter. Increased interest in recent years in CEUS technique and in the application of CEUS in novel fields like endoscopic ultrasound (EUS) has revolutionized indications and applications. As a result, the EFSUMB initiated a new update of the guidelines in 2011 to include this additional knowledge. Some of the contrast-enhanced EUS (CE-EUS) indications are established, whereas others are preliminary; these latter indications are categorized as emergent CEUS applications since the available evidence is insufficient for general recommendation. This article focuses on the use of CE-EUS in various clinical settings. The reader will get an overview of current indications and possible applications of CE-EUS. This involves the introduction of different contrast studies including color Doppler techniques (known as contrast-enhanced high mechanical index endosonography or CEHMI-EUS) as well as more modern high-resolution contrast-enhanced techniques (known as contrast-enhanced low mechanical index endosonography or CELMI EUS).

Accuracy of endoscopic ultrasound-guided tissue acquisition in the evaluation of lymph nodes enlargement in the absence of on-site pathologist

“…This result could have been related to the procurement of a non-diagnostic part of the lymph node, e.g ., the necrotic portion. Evidence suggests that employing complementary tools, such as contrast-enhanced EUS or EUS elastography, might help in guiding to the area for tissue procurement, thus improving the diagnostic yield[ 24 , 25 ]. However, further studies are required to validate the benefits of these advanced imaging techniques associated with EUS.…”

Evaluation of the viability of hepatocellular carcinoma in the caudate lobe using contrast-enhanced endoscopic ultrasonography after transarterial chemoembolization

“…[5] reported a detailed liver segmentation method for describing the anatomy of the liver based on findings obtained using a curvilinear echoendoscope. Regarding the diagnostic utility of EUS, including CE-EUS, there have been several reports about the use of EUS to diagnose various abdominal lesions;[6] however, no cases in which CE-EUS was employed to image HCC have been reported. As for the diagnosis of HCC using EUS, most previous studies in which such an approach was adopted involved EUS-guided fine-needle aspiration (EUS-FNA).…”

Present status and perspectives of endosonography 2017 in gastroenterology

“…In contrast, in harmonic EUS, the typically poor vascularization in pancreatic cancer can be displayed even better without the blooming effect of Doppler mode and this allows the differentiation from other pancreatic tumors, such as neuroendocrine tumors, metastasis of renal carcinoma and small cell lung cancer, or infiltration by a lymphoma, even in very small lesions [ 56 , 66 , 70 ]. In the current guidelines of the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB), contrast harmonic (endoscopic) ultrasound is recommended to determine whether EUS-FNA cytology exam should be performed, even in small resectable pancreatic lesions [ 71 - 80 ].…”