Comments and Illustrations Regarding the Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) – Update 2008

Zusammenfassung

Die aktuell veröffentlichten EFSUMB-Leittlinien und -Empfehlungen beschreiben die Anwendung von Ultraschallkontrastmitteln. Sie sind Gegenstand dieses Bildessays mit Kommentaren und ergänzender Literaturanalyse. CEUS ist zum wichtigsten bildgebenden Verfahren für fokale Leberläsionen geworden. Insbesondere wird die Charakterisierung von Lebertumoren detailliert beschrieben aber auch die Therapiekontrolle lokal ablativer Verfahren. Die Empfehlungen betreffen auch die Einsatzmöglichkeiten von Ultraschallkontrastmitteln für die Beurteilung der Nieren. Diskutiert werden die Detektion und Charakterisierung von fokalen Nierenläsionen sowie die Therapiekontrolle lokal ablativer Verfahren. CEUS und auch der kontrastverstärkte endoskopische Ultraschall können für die Charakterisierung von Pankreasläsionen genutzt werden. Das duktale Adenokarzinom als der häufigste Tumor des Pankreas zeigt typischerweise eine deutlich geringere Kontrastanreicherung im Vergleich zum angrenzenden pankreatischen Gewebe wogegen neuroendokrine Tumoren und das seröse mikrozystische Pankreasadenom durch eine Mehranreicherung charakterisiert sind. Diese Kenntnis ist wichtig für die Differenzialdiagnose von Pankreastumoren. Vesikoureteraler Reflux und stumpfes Bauchtrauma werden ebenfalls erwähnt. Andere Kapitel der Leitlinien sind in getrennten Artikeln dieses Supplements enthalten.

Abstract

The recently published EFSUMB guidelines and recommendations provide general advice for the use of ultrasound contrast agents to improve the management of patients. They are the subject of this pictorial essay, comments and analysis of the literature. CEUS has become the most important imaging method for focal liver diseases. Its uses are discussed in detail, especially the characterization of liver tumors and the monitoring of local treatment. The recommendations also deal with the uses of ultrasound contrast agents for the evaluation of the microvasculature and macrovasculature of the kidneys, including the characterization of focal renal lesions, the detection of lesions and the monitoring of local treatment. CEUS and contrast-enhanced endoscopic ultrasound can be used to characterize lesions. Ductal adenocarcinoma as the most common tumor of the pancreas is typically hypoenhanced compared to the adjacent pancreatic tissue in all phases. Neuroendocrine tumors and serous microcystic adenoma of the pancreas are characterized by hypervascularization appearing typically hyperenhanced during CEUS. This is of importance for a differential diagnosis. Vesicoureteric reflux and blunt abdominal trauma are also mentioned. Other parts or chapters of the guidelines are described in a separate paper of this supplement.

Key words

ultrasonography - guidelines - detection - characterisation - liver

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Recommended Reading (book)

• 131 Dietrich C F. Endoscopic ultrasound, an introductory manual and atlas. Thieme Verlag 2006
• 132 Dietrich C F. Endosonographie. Lehrbuch und Atlas des endoskopischen Ultraschalls. Thieme Verlag 2008
• 133 Lencioni R. Enhancing the role of ultrasound with contrast agents. Springer 2006
• 134 Dietrich C F. Ultraschall-Kurs (Hrsg.). Deutscher Ärzteverlag 2006
• 135 Wermke W. Sonographische Differenzialdiagnose Leberkrankheiten. Deutscher Ärzteverlag 2005

Recommended Reading (abstracts)

• 136 Bauditz J, Bodamer A, Wermke W. Kontrastmittelsonographie: Sind nach der Diagnose Pankreaskarzinom weitere Untersuchungen erforderlich?.  Ultraschall in Med. 2006;  27 S31
• 137 Bauditz J, Fondis K, Wermke W. Sonomorphologie und Kontrastverhalten von Fokal Nodulären Hyperplasien der Leber im Langzeitverlauf.  Ultraschall in Med. 2006;  27 S31
• 138 Clevert D, Jung E, Staehler M. et al . Charakterisierung fokaler Nierenläsion mittels kontrastverstärkter Low-MI-Technik im Vergleich zum CT und MRT.  Ultraschall in Med. 2006;  27 S33
• 139 Heide R, Strobel D. Kontrastmittelsonographie der Leber-Mittelklassegerät versus High-End-Gerät.  Ultraschall in Med. 2007;  28 S34
• 140 Seitz K, Judmaier G. Das erweiterte Repertoire der Sonografie: Kontrastverstärker, Radiofrequenzablation und Punktion.  Ultraschall in Med. 2007;  28 158-160
• 141 Strobel D, Seitz K, Blank W. et al . Klinischer Nutzen der Kontrastmittelsonographie in der Differentialdiagnose von Leberraumforderungen-Endauswertung der Multizenterstudie der Deutschen Gesellschaft für Ultraschall in Med.  Ultraschall in Med. 2007;  28 S31
• 142 Weskott H P, Andreesen H, Wang Z. et al . Kontrastmittelsonographie (CEUS) bei diffusen und umschriebenen Gallenblasenwandveränderungen.  Ultraschall in Med. 2006;  27 S32
• 143 Weskott H P, Wang Z. Kontrastmittelassoziierte Artefakte in der sonographischen Diagnostik.  Ultraschall in Med. 2006;  27 S28
• 144 Jedrzeyczyk M, Jakubowski W, Dietrich C F. et al . Reliability of estimation of the soft tissue perfusion with use time intensity curves (TIC) in contrast enhanced ultrasound-basic problems.  Ultrasonografia. 2008;  Supplement 1 75
• 145 Schuessler G, Ignee A, Terhorst G. et al . Charakterisierung von Nierentumoren durch signalverstärkten Ultraschall.  Ultraschall in Med. 2002;  23 S42
• 146 Ignee A, Braden B, Barreiros A P. et al . Contrast enhanced ultrasound for imaging of adrenal masses.  Ultraschall in Med. 2008;  29 S27
• 147 Ignee A, Erdmann J, Selbach J. et al . Safety and efficacy of biopsy of renal masses guided by ultrasound.  Ultraschall in Med. 2008;  29 S27