Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2020 – WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS

Abstract

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.

Performance of Ultrasound Techniques and the Potential of Artificial Intelligence in the Evaluation of Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease

“…Currently, there are four Food and Drug Administration (FDA)-approved UCAs available worldwide: SonoVue/Lumason (Bracco Suisse SA, Geneva, Switzerland), Definity/Luminity (Lantheus Medical Imaging, Inc., North Billerica, MA, USA), Optison, and Sonazoid (GE Healthcare AS, Oslo, Norway) [ 61 ]. These UCAs consist of biodegradable gas microbubbles, equal or smaller in size than red blood cells, stabilized in a phospholipid or albumin shell [ 58 , 59 ].…”

“…Regardless of whether microbubbles are within the reticuloendothelial system or utterly within the blood pool, they can be easily destroyed by the ultrasound energy emitted by the examiner, providing real-time visualization of different vascular phases [ 60 ]. Given the dual blood supply of the liver, from the hepatic artery and the portal vein (25–30% and 70–75% of the total blood supply respectively), three different vascular phases have been defined: the arterial (AP), portal venous (PVP), and the late (LP) phase [ 61 ].…”

“…Moreover, UCAs enable the characterization of the vascular architecture through the phase-specific contrast enhancement in comparison to the background liver parenchyma. These characteristics are highly suggestive diagnostic features for various FLLs [ 60 , 61 ]. However, it is mandatory to perform a thorough B-mode and color Doppler US evaluation of the liver beforehand, considering that cysts and calcifications can be easily misinterpreted due to complete absence of enhancement.…”

Ultrasound-targeted microbubble destruction promotes myocardial angiogenesis and functional improvements in rat model of diabetic cardiomyopathy

“…As an ultrasound contrast agent, SonoVue (Bracco International BV, Amsterdam, Netherlands) showed high safety, good contrast-enhanced images in clinical use [14][15][16]. The present study aims to investigate the effects of SonoVue/UTMD combined treatment on myocardial angiogenesis and inspect the optimal ultrasonic parameters in a rat model of DCM.…”

Letter to the Editor on the Article: “Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review” by Jacobsen N et al.

“…CETUS is a real-time ultrasound technique evaluating tissue perfusion using an injected suspension of gas microbubbles that enhances the echogenicity of the intravascular 'blood pool'. Registered indications in Europe for ultrasound contrast agents use are cardiac, macrovascular, liver and breast lesions [2,3]. Despite the fact that a role for CETUS in lung diseases is still far from established, its use for US-guided interventional procedures and noninvasive characterization of lung subpleural lesions has been proposed.…”