Ultraschall Med 2004; 25(4): 249-256
DOI: 10.1055/s-2004-813245
Guidelines

© Georg Thieme Verlag KG Stuttgart · New York

Guidelines for the Use of Contrast Agents in Ultrasound - January 2004

Leitlinien für den Gebrauch von Ultraschallkontrastmitteln - Januar 2004T. Albrecht1 , M. Blomley1 , L. Bolondi1 , M. Claudon1 , J.-M Correas1 , D. Cosgrove1 , L. Greiner1 , K. Jäger1 , N. de Jong1 , E. Leen1 , R. Lencioni1 , D. Lindsell1 , A. Martegani1 , L. Solbiati1 , L. Thorelius1 , F. Tranquart1 , H. P. Weskott1 , T. Whittingham1
  • 1Thomas Albrecht, Germany; Martin Blomley, UK ; Luigi Bolondi, Italy; Michel Claudon France; Jean-Michel Correas, France; David Cosgrove, UK; Lucas Greiner, Germany; Kurt Jäger, Switzerland; Nico de Jong, Netherlands; Eddie Leen, UK; Riccardo Lencioni, Italy; David Lindsell, UK; Alberto Martegani, Italy; Luigi Solbiati, Italy; Lars Thorelius, Sweden; François Tranquart, France; Hans Peter Weskott, Germany; Tony Whittingham, UK
With the advice and educational grant provided by the following companies:Amersham, Bristol-Myers Squibb Medical Imaging; Bracco; Esaote; GE Ultrasound; Hitachi; Philips; Schering; Siemens; Toshiba.
Further Information

Publication History

Publication Date:
09 August 2004 (online)

Ultrasound contrast agents (UCA), in conjunction with contrast specific imaging techniques, are increasingly accepted in clinical use for diagnostic imaging and post-interventional workup in several organs. Presently, there is no guidance document providing a description of essential technical requirements, proposed investigator qualifications, suggested investigational procedures and steps, guidance on image interpretation, recommended and established clinical indications and safety considerations.

The need for these guidelines was highlighted following the EFSUMB Board of Directors (Delegates) meeting at the EUROSON Congress at Copenhagen in March, 2003. During their development these guidelines were presented at the EFSUMB special consensus meeting for the use of contrast agents in ultrasound in Rotterdam in January 2004.

These guidelines are based on comprehensive literature surveys including results from prospective clinical trials. On issues where no significant study data were available, evidence was obtained from expert committee reports or was based on the actual consensus of experts in the field of US and contrast enhanced Ultrasound (CEUS) during the consensus conference.

These guidelines are intended to create standard protocols for the use and administration of UCA and improve the management of patients. The first version, dated January 2004, will be focused on the evaluation of known or suspected focal liver lesions (FLL).

These guidelines are intended to give general advice for the use of UCA. Individual cases must be managed on the basis of all clinical data available for that specific case. The guidelines will be subject to change to reflect future advances in scientific knowledge and the rapidly evolving field of US technology.

5 References

  • 1 Correas J M, Bridal L, Lesavre A. et al . Ultrasound contrast agents: properties, principles of action, tolerance, and artifacts.  Eur Radiol. 2001;  11 (8) 1316-1328
  • 2 Bauer A, Solbiati L. Ultrasound contrast agents. Solbiati L Contrast-enhanced ultrasound of liver diseases Springer; Milan 2003: 21-26
  • 3 Burns P. Contrast ultrasound technology. Solbiati L Contrast-enhanced ultrasound of liver diseases Springer; Milan 2003: 1-18
  • 4 Bernatik T, Becker D, Neureiter D. et al . Detection of liver metastases - comparison of contrast-enhanced ultrasound using first versus second generation contrast agents.  Ultraschall in Med. 2003;  24 (3) 175-179
  • 5 Leen E, Horgan P. Ultrasound contrast agents for hepatic imaging with nonlinear modes.  Curr Probl Diagn Radiol. 2003;  32 (2) 66-87
  • 6 Basilico R, Blomley M J, Harvey C J. et al . Which continuous US scanning mode is optimal for the detection of vascularity in liver lesions when enhanced with a second generation contrast agent?.  Eur J Radiol. 2002;  41 (3) 184-191
  • 7 Schrope B A, Newhouse V L. Second harmonic ultrasonic blood perfusion measurement.  Ultrasound Med Biol. 1993;  19 (7) 567-579
  • 8 Burns P, Powers J, Hope Simpson U D. et al . Harmonic Imaging: principles and preliminary results.  Angiology. 1996;  47 S63-S74
  • 9 Simpson D H, Chin C T, Burns P N. Pulse inversion Doppler: a new method for detecting nonlinear echoes from microbubble contrast agents. IEEE Trans on Ultrasonics, Ferroelectrics, and Freq.  Control. 1999;  46 372-382
  • 10 Averkiou M, Powers J, Skyba D. et al . Ultrasound contrast imaging research.  Ultrasound Q. 2003;  19 (1) 27-37
  • 11 Tiemann K, Lohmeier S, Kuntz S. et al . Real-Time Contrast Echo Assessment of Myocardial Perfusion at Low Emission Power: First Experimental and Clinical Results Using Power Pulse Inversion Imaging.  Echocardiography. 1999;  16 (8) 799-809
  • 12 Beissert M, Delorme S, Mutze S. et al . Comparison of B-mode and conventional colour/power Doppler ultrasound, contrast-enhanced Doppler ultrasound and spiral CT in the diagnosis of focal lesions of the liver: Results of a multicentre study.  Ultraschall in Med. 2002;  23 (4) 245-250
  • 13 Albrecht T, Blomley M J, Burns P N. et al . Improved detection of hepatic metastases with pulse-inversion US during the liver-specific phase of SHU 508A: multicenter study.  Radiology. 2003;  227 (2) 361-370
  • 14 Kono Y, Steinbach G C, Peterson T. et al . Mechanism of parenchymal enhancement of the liver with a microbubble-based US contrast medium: an intravital microscopy study in rats.  Radiology. 2002;  224 (1) 253-257
  • 15 Albrecht T, Blomley M J. Characteristics of hepatic hemangiomas at contrast-enhanced harmonic US.  Radiology. 2001;  220 (1) 269-270
  • 16 Strobel D, Hoefer A, Martus P. et al . Dynamic contrast-enhanced power Doppler sonography improves the differential diagnosis of liver lesions.  Int J Colorectal Dis. 2001;  16 (4) 247-256
  • 17 Dill-Macky M J, Burns P N, Khalili K. et al . Focal hepatic masses: enhancement patterns with SH U 508A and pulse-inversion US.  Radiology. 2002;  222 (1) 95-102
  • 18 Wilson S R, Burns P N, Muradali D. et al . Harmonic hepatic US with microbubble contrast agent: initial experience showing improved characterization of hemangioma, hepatocellular carcinoma, and metastasis.  Radiology. 2000;  215 (1) 153-161
  • 19 Hohmann J, Skrok J, Puls R. et al . Characterization of focal liver lesions with contrast-enhanced low MI real time ultrasound and SonoVue.  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2003;  175 (6) 835-843
  • 20 Albrecht T, Blomley M J, Heckemann R A. et al . Stimulated acoustic emissions with the ultrasound contrast medium levovist: a clinically useful contrast effect with liver-specific properties.  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2000;  172 (1) 61-67
  • 21 Quaia E, Stacul F, Bertolotto M. et al . Characterization of focal liver lesions with pulse inversion harmonic imaging (PIHI) using a second generation US contrast agent.  Acad Radiol. 2002;  9 (Suppl 2) S376-S379
  • 22 Leen E. The role of contrast-enhanced ultrasound in the characterisation of focal liver lesions.  Eur Radiol. 2001;  11 (Suppl 3) E27-E34
  • 23 Quaia E, Degobbis F, Tona G. et al . Differential patterns of contrast enhancement in different focal liver lesions after injection of the microbubble US contrast agent SonoVue.  Radiol Med (Torino). 2004;  107 (3) 155-165
  • 24 Blomley M J, Sidhu S, Cosgrove D O. et al . Do different types of liver lesions differ in their uptake of the microbubble contrast agent SH U 508A in the late liver phase?.  Early experience. Radiology. 2001;  220 (3) 661-667
  • 25 Bryant T, Blomley M, Albrecht T. Liver phase uptake of a liver specific microbubble improves characterization of liver lesions: a multicenter study.  Radiology. 2004;  (in press)
  • 26 Dietrich C, Ignee A, Trojan J. et al . Improved characterisation of histologically proven liver tumours by contrast enhanced ultrasonography during the portal venous and specific late phase of SHU 508A.  Gut. 2004;  53 401-405
  • 27 Harvey C J, Blomley M J, Eckersley R J. et al . Hepatic malignancies: improved detection with pulse-inversion US in late phase of enhancement with SH U 508A-early experience.  Radiology. 2000;  216 (3) 903-908
  • 28 Albrecht T, Hoffmann C W, Schmitz S A. et al . Phase-inversion sonography during the liver-specific late phase of contrast enhancement: improved detection of liver metastases.  AJR Am J Roentgenol. 2001;  176 (5) 1191-1198
  • 29 Hohmann J, Albrecht T, Hoffmann C W. et al . Ultrasonographic detection of focal liver lesions: increased sensitivity and specificity with microbubble contrast agents.  Eur J Radiol. 2003;  46 (2) 147-159
  • 30 Albrecht T, Oldenburg A, Hohmann J. et al . Imaging of liver metastases with contrast-specific low-MI real-time ultrasound and SonoVue.  Eur Radiol. 2003;  13 (Suppl 3) N79-N86
  • 31 Dalla P alma L, Bertolotto M, Quaia E. et al . Detection of liver metastases with pulse inversion harmonic imaging: preliminary results.  Eur Radiol. 1999;  9 (Suppl 3) S382-S387
  • 32 Llovet J M, Beaugrand M. Hepatocellular carcinoma: present status and future prospects.  J Hepatol. 2003;  38 (Suppl 1) S136-S149
  • 33 Bruix J, Llovet J M. Prognostic prediction and treatment strategy in hepatocellular carcinoma.  Hepatology. 2002;  35 (3) 519-524
  • 34 Rhim H, Goldberg S N, Dodd 3rd G D. et al . Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors.  Radiographics. 2001;  21 S17-S35 discussion S36-S39
  • 35 de Baere T, Elias D, Dromain C. et al . Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year.  AJR Am J Roentgenol. 2000;  175 (6) 1619-1625 , et al
  • 36 Lencioni R A, Allgaier H P, Cioni D. et al . Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection.  Radiology. 2003;  228 (1) 235-240
  • 37 Cioni D, Lencioni R, Rossi S. et al . Radiofrequency thermal ablation of hepatocellular carcinoma: using contrast-enhanced harmonic power doppler sonography to assess treatment outcome.  AJR Am J Roentgenol. 2001;  177 (4) 783-788
  • 38 Cova L, Solbiati L, Lerace T. Usefulness of contrast-enhanced ultrasonography and real-time low mechanical index harmonic imaging in the selection and monitoring of patients undergoing percutaneous radiofrequency thermal ablation of liver tumors.  Eur Radiol. 2003;  13 S124

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