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      Contrast-Enhanced Ultrasound Imaging of Uterine Disorders: A Systematic Review

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          Abstract

          Uterine disorders are often presented with overlapping symptoms. The microvasculature holds specific information important for diagnosing uterine disorders. Conventional sonography is an established diagnostic technique in gynecology, but is limited by its inability to image the microvasculature. Contrast-enhanced ultrasound (CEUS), is capable of imaging the microvasculature by means of intravascular contrast agents; that is, gas-filled microbubbles. We provide a literature overview on the use of CEUS in diagnosing myometrial and endometrial disorders, that is, fibroids, adenomyosis, leiomyosarcomas and endometrial carcinomas, as well as for monitoring and enhancing the effectiveness of minimally invasive therapies. A systematic literature search with quality assessment was performed until December 2020. In total 34 studies were included, published between 2007 and 2020.The results entail a description of contrast-enhancement patterns obtained from healthy tissue and from malignant and benign tissue; providing a first base for potential diagnostic differentiation in gynecology. In addition it is also possible to determine the degree of myometrial invasion in case of endometrial carcinoma using CEUS. The effectiveness of minimally invasive therapies for uterine disorders can safely and accurately be assessed with CEUS. In conclusion, the abovementioned applications of CEUS are promising and it is worth further exploring its full potential for gynecology by designing innovative and methodologically high-quality clinical studies.

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          Most cited references61

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          QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.

          In 2003, the QUADAS tool for systematic reviews of diagnostic accuracy studies was developed. Experience, anecdotal reports, and feedback suggested areas for improvement; therefore, QUADAS-2 was developed. This tool comprises 4 domains: patient selection, index test, reference standard, and flow and timing. Each domain is assessed in terms of risk of bias, and the first 3 domains are also assessed in terms of concerns regarding applicability. Signalling questions are included to help judge risk of bias. The QUADAS-2 tool is applied in 4 phases: summarize the review question, tailor the tool and produce review-specific guidance, construct a flow diagram for the primary study, and judge bias and applicability. This tool will allow for more transparent rating of bias and applicability of primary diagnostic accuracy studies.
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            The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications.

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              Microbubbles and ultrasound: from diagnosis to therapy.

              The development of ultrasound contrast agents, containing encapsulated microbubbles, has increased the possibilities for diagnostic imaging. Ultrasound contrast agents are currently used to enhance left ventricular opacification, increase Doppler signal intensity, and in myocardial perfusion imaging. Diagnostic imaging with contrast agents is performed with low acoustic pressure using non-linear reflection of ultrasound waves by microbubbles. Ultrasound causes bubble destruction, which lowers the threshold for cavitation, resulting in microstreaming and increased permeability of cell membranes. Interestingly, this mechanism can be used for delivery of drugs or genes into tissue. Microbubbles have been shown to be capable of carrying drugs and genes, and destruction of the bubbles will result in local release of their contents. Recent studies demonstrated the potential of microbubbles and ultrasound in thrombolysis. In this article, we will review the recent advances of microbubbles as a vehicle for delivery of drugs and genes, and discuss possible therapeutic applications in thrombolysis.
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                Author and article information

                Journal
                Ultrason Imaging
                Ultrason Imaging
                UIX
                spuix
                Ultrasonic Imaging
                SAGE Publications (Sage CA: Los Angeles, CA )
                0161-7346
                1096-0910
                26 May 2021
                September 2021
                : 43
                : 5
                : 239-252
                Affiliations
                [1 ]Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
                [2 ]Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
                [3 ]Katholieke Universiteit Leuven UZ Leuven, Leuven, Belgium
                [4 ]Amsterdam UMC Locatie De Boelelaan, Amsterdam, The Netherlands
                Author notes
                [*]Barbara Stoelinga, Amsterdam UMC Location VUmc, Boelelaan 1117, 1081HV Amsterdam, The Netherlands. Email: b.stoelinga@ 123456amsterdamumc.nl
                Author information
                https://orcid.org/0000-0002-6595-4433
                Article
                10.1177_01617346211017462
                10.1177/01617346211017462
                8299780
                34036872
                6ffe4469-d749-4713-8e17-9521068048fb
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                Technical Articles
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                ts1

                contrast-enhanced ultrasound,imaging,microvasculature,uterine disorders,systematic review

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