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      Advantages and Limitations of Focal Liver Lesion Assessment with Ultrasound Contrast Agents: Comments on the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines

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          Abstract

          Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in sonography. Due to US contrast agents (UCAs) and contrast-specific techniques, sonography offers the potential to show enhancement of liver lesions in a similar way as contrast-enhanced cross-sectional imaging techniques. The real-time assessment of liver perfusion throughout the vascular phases, without any risk of nephrotoxicity, represents one of the major advantages that this technique offers. CEUS has led to a dramatic improvement in the diagnostic accuracy of US and subsequently has been included in current guidelines as an important step in the diagnostic workup of focal liver lesions (FLLs), resulting in a better patient management and cost-effective therapy. The purpose of this review was to provide a detailed description of contrast agents used in different cross-sectional imaging procedures for the study of FLLs, focusing on characteristics, indications and advantages of UCAs in clinical practice.

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          The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications.

          F Piscaglia, C Nolsøe, C Dietrich … (2012)
          Article 0 comments Cited 213 times – based on 0 reviews     Review now
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            Diagnosis, epidemiology and outcomes of acute kidney injury.

            K. Liu, Sushrut S Waikar, Glenn Chertow (2008)
            Acute kidney injury is an increasingly common and potentially catastrophic complication in hospitalized patients. Early observational studies from the 1980s and 1990s established the general epidemiologic features of acute kidney injury: the incidence, prognostic significance, and predisposing medical and surgical conditions. Recent multicenter observational cohorts and administrative databases have enhanced our understanding of the overall disease burden of acute kidney injury and trends in its epidemiology. An increasing number of clinical studies focusing on specific types of acute kidney injury (e.g., in the setting of intravenous contrast, sepsis, and major surgery) have provided further details into this heterogeneous syndrome. Despite our sophisticated understanding of the epidemiology and pathobiology of acute kidney injury, current prevention strategies are inadequate and current treatment options outside of renal replacement therapy are nonexistent. This failure to innovate may be due in part to a diagnostic approach that has stagnated for decades and continues to rely on markers of glomerular filtration (blood urea nitrogen and creatinine) that are neither sensitive nor specific. There has been increasing interest in the identification and validation of novel biomarkers of acute kidney injury that may permit earlier and more accurate diagnosis. This review summarizes the major epidemiologic studies of acute kidney injury and efforts to modernize the approach to its diagnosis.
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              Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS.

              M Claudon, C Dietrich, B Choi … (2013)
              Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide. © Georg Thieme Verlag KG Stuttgart · New York.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Princ Pract
                Journal ID (iso-abbrev): Med Princ Pract
                Journal ID (publisher-id): MPP
                Title: Medical Principles and Practice
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                ISSN (Print): 1011-7571
                ISSN (Electronic): 1423-0151
                Publication date (Print): August 2016
                Publication date (Electronic): 17 June 2016
                Publication date PMC-release: 17 June 2016
                Volume: 25
                Issue: 5
                Pages: 399-407
                Affiliations
                [1] aDepartment of Internal Medicine, Wuhan, China
                [2] bDepartment of Radiology, Caritas Hospital, Bad Mergentheim, Germany
                [3] cDepartment of Medical Imaging, des Cévennes Clinic, Annonay, France
                [4] dDepartment of Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Guastalla, Italy
                [5] eDepartment of Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
                [6] fDepartment of Radiology and Computed Tomography, Wuhan, China
                [7] gDepartment of Gastroenterology, ‘Octavian Fodor’ Institute of Gastroenterology and Hepatology and ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, Cluj-Napoca, Romania
                [8] hDepartment of Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                Author notes
                *Prof. Dr. med. Christoph F. Dietrich, Innere Medizin 2, Caritas Krankenhaus, Uhlandstrasse 7, DE—97980 Bad Mergentheim (Germany), E-Mail christoph.dietrichs@ 123456ckbm.de
                Article
                Publisher ID: mpp-0025-0399
                DOI: 10.1159/000447670
                PMC ID: 5588445
                PubMed ID: 27318740
                SO-VID: c36ca155-0345-4ec4-a505-fbc7d4d271f2
                Copyright © Copyright © 2016 by S. Karger AG, Basel
                License:

                This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.

                History
                Date received : 6 August 2015
                Date accepted : 16 June 2016
                Page count
                Figures: 3, Tables: 1, References: 87, Pages: 9
                Categories
                Subject: Review

                Keywords: guidelines,focal liver lesions,contrast-enhanced ultrasound,computed tomography,magnetic resonance imaging
                Data availability:
                Keywords: guidelines, focal liver lesions, contrast-enhanced ultrasound, computed tomography, magnetic resonance imaging

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