EFSUMB Technical Review – Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion

Abstract

Dynamic contrast-enhanced ultrasound (DCE-US) is a technique to quantify tissue perfusion based on phase-specific enhancement after the injection of microbubble contrast agents for diagnostic ultrasound. The guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published in 2004 and updated in 2008, 2011, and 2020 focused on the use of contrast-enhanced ultrasound (CEUS), including essential technical requirements, training, investigational procedures and steps, guidance regarding image interpretation, established and recommended clinical indications, and safety considerations. However, the quantification of phase-specific enhancement patterns acquired with ultrasound contrast agents (UCAs) is not discussed here. The purpose of this EFSUMB Technical Review is to further establish a basis for the standardization of DCE-US focusing on treatment monitoring in oncology. It provides some recommendations and descriptions as to how to quantify dynamic ultrasound contrast enhancement, and technical explanations for the analysis of time-intensity curves (TICs). This update of the 2012 EFSUMB introduction to DCE-US includes clinical aspects for data collection, analysis, and interpretation that have emerged from recent studies. The current study not only aims to support future work in this research field but also to facilitate a transition to clinical routine use of DCE-US.

Application of Dynamic Contrast-Enhanced Ultrasound in Evaluation the Activity of Crohn’s Disease

“…DCE-US is a technique to quantify the tissue perfusion down to the capillary level based on phase-specific enhancement after injecting the contrast agents for diagnostic ultrasound, which can be applied to the evaluation of inflammatory activity. Since it is assumed that the signal intensity in DCE-US is proportional to the number of microbubbles, the TIC parameters are correlated with the vascularization of the analyzed region [30]. After curve fitting, quantitative parameters from TICs provide an objective assessment of the time and degree of wash-in and wash-out to quantitatively evaluate the bowel micro-vascular perfusion in active and inactive CD patients.…”

“…In our study, all positive perfusion parameters and intestinal US features (including BWT, color Doppler signal, and MLN) were combined, and the best diagnostic performance was obtained with AUROC 0.987 (95% CI: 0.958-1.000), with 97.4% sensitivity, 100% specificity, and 98.1% accuracy. Repetitive perfusion parameters obtained by DCE-US evaluate the degree of inflammation, which can be more accessible and explained by the operator, regardless of the level of experience [30]. Based on DCE-US quantitative analysis, a relevant ultrasound diagnostic model can be constructed to objectively evaluate the CD activity in future studies.…”