Perfusion Quantification in Contrast-Enhanced Ultrasound (CEUS) – Ready for Research Projects and Routine Clinical Use

Abstract

With contrast-enhanced ultrasound (CEUS) now established as a valuable imaging modality for many applications, a more specific demand has recently emerged for quantifying perfusion and using measured parameters as objective indicators for various disease states. However, CEUS perfusion quantification remains challenging and is not well integrated in daily clinical practice. The development of VueBox™ alleviates existing limitations and enables quantification in a standardized way. VueBox™ operates as an off-line software application, after dynamic contrast-enhanced ultrasound (DCE-US) is performed. It enables linearization of DICOM clips, assessment of perfusion using patented curve-fitting models, and generation of parametric images by synthesizing perfusion information at the pixel level using color coding. VueBox™ is compatible with most of the available ultrasound platforms (nonlinear contrast-enabled), has the ability to process both bolus and disruption-replenishment kinetics loops, allows analysis results and their context to be saved, and generates analysis reports automatically. Specific features have been added to VueBox™, such as fully automatic in-plane motion compensation and an easy-to-use clip editor. Processing time has been reduced as a result of parallel programming optimized for multi-core processors. A long list of perfusion parameters is available for each of the two administration modes to address all possible demands currently reported in the literature for diagnosis or treatment monitoring. In conclusion, VueBox™ is a valid and robust quantification tool to be used for standardizing perfusion quantification and to improve the reproducibility of results across centers.

Zusammenfassung

Beim kontrastverstärkten Ultraschall (CEUS), der sich jetzt in vielen Anwendungsbereichen als wertvolle darstellende Modalität durchgesetzt hat, ist mit der Quantifizierung der Perfusion und der Verwendung der ermittelten Parameter als objektive Indikatoren für verschiedene Erkrankungsstadien nun eine sehr spezielle Anforderung entstanden. Allerdings ist die Perfusionsquantifizierung mittels CEUS anspruchsvoll und noch nicht ausreichend in den klinischen Alltag integriert. Die Entwicklung von VueBox^TM verringert die bestehenden Einschränkungen und ermöglicht eine Quantifizierung in standardisierter Weise. VueBox^TM arbeitet als Anwender-Software im Off-line-Modus, nachdem eine dynamische kontrastverstärkte Sonografie (DCE-US) durchgeführt wurde. Sie ermöglicht die Linearisierung von DICOM-Clips, die Bewertung der Perfusion mittels patentierter Curve-fitting-Modelle und die Erzeugung parametrischer Darstellungen durch die Synthetisierung der Perfusionsinformation auf der Pixel-Ebene mittels Farbkodierung. VueBox^{TM ist} ist mit den meisten der verfügbaren Ultraschallplattformen (die nicht linearen Kontrast ermöglichen) kompatibel, kann sowohl kinetische Bolus- als auch Disruptions-Regenerations-Schleifen verarbeiten, ermöglicht die Speicherung der Analyseergebnisse und deren Inhalte und erstellt die Analyseprotokolle automatisch. Spezielle Funktionen wurden der VueBox^TM hinzugefügt, wie der vollautomatische Bewegungsausgleich in der Ebene und einen einfach zu bedienenden Clip-Editor. Die Verarbeitungszeit wurde aufgrund der Verbesserung der parallelen Programmierung der Multicore-Prozessoren verkürzt. Eine große Bandbreite an Perfusionsparametern ist bei jedem der beiden Administrationsmodi verfügbar, um alle möglichen Anforderungen, die derzeit für die Diagnose und die Therapieüberwachung in der Literatur berichtet werden, zu erfüllen. Abschließend lässt sich sagen, dass VueBox^TM eine nützliche und robuste Quantifizierungsmethode ist, um eine standardisierte Perfusionsquantifizierung durchzuführen und die Reproduzierbarkeit der Befunde zwischen den Zentren zu verbessern.

Key words

dynamic contrast-enhanced ultrasound - perfusion - quantification - treatment monitoring - parametric images.

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