The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version)

Abstract

ABSTR AC TThe updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.

Pancreatic Ultrasound: State of the Art

“…medium injection during a US examination done for a suspicious pancreatic disease is the first recommendation present in the 2017 European CEUS application guidelines for nonhepatic diseases: all of the pancreatic focal lesions identified by conventional US could be studied with CEUS to increase characterization in ductal adenocarcinoma diagnosis. 36 Contrast-enhanced US allows both local tumor staging, revealing clear relationships with peripancreatic vessels and eventually their infiltration, and liver staging, by studying the liver in the late phase, when possible metastases are seen as hypovascularity with wash-out. The late phase is the best phase for metastatic liver lesion detection, and each solid hypoechoic focal liver lesion detected during the late phase should be considered a metastasis until proven otherwise.…”

“…21 In the literature, there is numerous evidence that CEUS can be a useful tool to improve pancreatic neuroendocrine tumor characterization during a firstline examination. 36,45 Serous Cystadenoma Among serous pancreatic neoplasms, serous cystadenoma is the most common, and it is usually detected in middle age (50-60 years) in women (female-tomale ratio, 2:1), and in the head of the pancreas, with benign behavior. 46 The most frequent type of these lesions is the microcystic type (70% of cases), and it presents as a solitary multilocular microcystic lesion with a honeycomb architecture due to multiple microcysts smaller than 20 mm, a thin wall, and thin multiple centripetal septa.…”

“…2 In cases of cystic pancreatic lesions, the correct procedure for a better US evaluation is contrast medium injection, as reported by the 2017 European Federation of Societies for Ultrasound in Medicine and Biology guidelines. 36 In fact, lesion vegetation enhancement, due to its vascularization, could be better shown on CEUS imaging with respect to other contrast imaging modalities because of the real-time evaluation and high spatial resolution. Contrast-enhanced US can be a safe, noninvasive, and low-cost method to follow borderline IPMNs, assessing changes in sizes and showing vascularized vegetations.…”

Dynamic assessment of venous anatomy and function in neurosurgery with real-time intraoperative multimodal ultrasound: technical note

“…[13][14][15][16][17][18][19][20] In general, the US contrast agent is prepared and injected through a peripheral vein. Different vascular phases are analyzed: basal, arterial, peak, parenchymal, and venous.…”

“…Its use in neurosurgery has been recently included in the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines. 13,[16][17][18]20 In this paper, we provide technical background on which modalities to apply when evaluating the venous circulation in neurosurgical procedures, and we review different clinical scenarios, demonstrating how the combination of different US modalities has the potential to detect all those dynamic changes that take place within the venous system during cranial surgery, and discuss the importance of the assessment of the extracranial venous system and its impact on cerebral venous drainage.…”