Ultralydsymposium - NORSK FORENING FOR ULTRALYD ...

New EFSUMB Guidelines and Recommendations on theClinical Practice of CEUS in non-hepatic applicationsOdd Helge Gilja, National Centre for Ultrasound in Gastroenterology, HaukelandUniversity Hospital, and Institute of Medicine, University of Bergen, Bergen, NorwayThe European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB)released the first Guidelines on the use of CEUS in 2004. This document focused mainlyon liver applications and contributed to a rapid expansion of CEUS world-wide. An updateof the Clinical Recommendations on CEUS by EFSUMB was published in 2008, in whicha few applications in other organs were described. Since then there has been anexponentially increasing interest in the clinical applications of CEUS and new fields havebeen investigated, so that nearly all organ systems have now been subject to some kind ofCEUS study. Accordingly, in 2010 EFSUMB decided to start preparing a new update ofthe Guidelines, now including a vast list of other applications:Pediatric, Pancreas, Endoscopic CEUS, Gastrointestinal tract, Spleen, Kidney,Vesicoureteral reflux, Scrotum, Abdominal Trauma, Lung and pleural lesions, Vascular,Cerebral vessels, Inflammatory joints disease, Intracavitary, Lymphnodes, Tumourresponse assessment, Breast, Adrenals, Gynecology, Perineum, Urinary Bladder,Transplanted Kidney, Prostate Cancer, Aorto-caval fistulae, Free Tissue Transplants,Extrahepatic Biliary System, and the use in patients with renal failure.However, the operator must keep in mind that CEUS still remains off-label for many nonliverindications contained in the present recommendations. This means that patientsshould be informed and consented to the investigation, and this is the responsibility of theoperator.Any CEUS examination should be preceded by careful assessment of the target withconventional B-mode ultrasound and, when appropriate, with Doppler techniques. Beforestarting the CEUS examination, relevant clinical information, including laboratory testsand previous imaging investigations, should be reviewed. This also helps in explaining tothe patient the expected benefit of the proposed CEUS study, an important step inobtaining consent.For SonoVue ® , which is the most used CA in Europe, the recommended dose is 2.4 mL.This can be increased to 4.8 mL or decreased to 1.0 mL or less depending on the sensitivityof the equipment used, the type of transducer and the organ under investigation. Whenusing higher frequency transducers, 4.8 mL dose usually performs better. A real-timevideo-clip should be recorded, preferably digitally, for review and for documentation.In the lecture, focus will be on abdominal applications, particularly pancreas and intestine.References1. Piscaglia F, Nolsøe C, Dietrich CF, Cosgrove DO, Gilja OH, Bachmann Nielsen M,Albrecht T, Barozzi L, Bertolotto M, Catalano O, Claudon M, Clevert DA, Correas JM,D'Onofrio M, Drudi FM, Eyding J, Giovannini M, Hocke M, Ignee A, Jung EM,Klauser AS, Lassau N, Leen E, Mathis G, Saftoiu A, Seidel G, Sidhu PS, Haar GT,Timmerman D, Weskott HP. The EFSUMB Guidelines and Recommendations on theClinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on nonhepaticapplications. Ultraschall Med. 2011 Aug 26. PMID: 21874631.