How to perform Contrast-Enhanced Ultrasound (CEUS)

Christoph F Dietrich¹, Michalakis Averkiou², Michael Bachmann Nielsen³, Richard G Barr⁴, Peter N Burns⁵, Fabrizio Calliada⁶, Vito Cantisani⁷, Byung Choi⁸, Maria C Chammas⁹, Dirk-André Clevert¹⁰, Michel Claudon¹¹, Jean-Michel Correas¹², Xin-Wu Cui¹³, David Cosgrove¹⁴, Mirko D'Onofrio¹⁵, Yi Dong¹⁶, JohnR Eisenbrey¹⁷, Teresa Fontanilla¹⁸, Odd Helge Gilja¹⁹, Andre Ignee¹³, Christian Jenssen²⁰, Yuko Kono²¹, Masatoshi Kudo²², Nathalie Lassau²³, Andrej Lyshchik¹⁷, Maria Franca Meloni²⁴, Fuminori Moriyasu²⁵, Christian Nolsøe²⁶, Fabio Piscaglia²⁷, Maija Radzina²⁸, Adrian Saftoiu²⁹, Paul S Sidhu³⁰, Ioan Sporea³¹, Dagmar Schreiber-Dietrich³², Claude B Sirlin³³, Maria Stanczak¹⁷, Hans-Peter Weskott³⁴, Stephanie R Wilson³⁵, Juergen Karl Willmann³⁶, Tae Kyoung Kim³⁷, Hyun-Jung Jang³⁷, Alexandar Vezeridis³⁸, Sue Westerway³⁹

Affiliations

¹ Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany and Ultrasound Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Bioengineering, University of Washington, Seattle, United States.
³ Rigshospitalet, Dep. of Radiology, Copenhagen, Denmark.
⁴ Radiology, Northeastern Ohio Medical University, Rootstown, United States.
⁵ Dept Medical Biophysics, University of Toronto. Sunnybrook Research Institute, Toronto, Canada.
⁶ Policlinico San Matteo, University of Pavia, Department of Radiology, Pavia, Italy.
⁷ Department of Radiology, "Sapienza" University of Rome, ROME, Italy.
⁸ Department of Radiology, Chung-Ang University Hosptial, Seoul, Korea (the Republic of).
⁹ Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil.
¹⁰ Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany.
¹¹ Department of Pediatric Radiology, Centre Hospitalier Universitaire de Nancy and Université de Lorraine, Vandoeuvre, France.
¹² Hopital universitaire Necker-Enfants malades, Service de Radiologie Adultes, Paris, France.
¹³ Department of Medical Ultrasound, Tongji Hospital of Tongji Medical college, Huahzong University of Science and technology, Wuhan, China.
¹⁴ Imperial College London, Imaging, London, United Kingdom of Great Britain and Northern Ireland.
¹⁵ Radiology, University of Verona, Verona, Italy.
¹⁶ Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
¹⁷ Department of Radiology, Thomas Jefferson University, Philadelphia, United States.
¹⁸ Radiology, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain.
¹⁹ National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway.
²⁰ Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany.
²¹ Department of Medicine and Radiology, University of California, San Diego, United States.
²² Kinki Daigaku Igakubu, Department Gastroenterology and Hepatology, Osakasayama, Osaka, Japan.
²³ Gustave Roussy and IR4MUMR8081. Université Paris-Sud, Université Paris-Saclay, Radiology, Paris, France.
²⁴ Radiology Department of Interventional Ultrasound - Casa di cura Igea- Milano, Italy.
²⁵ Sanno Hospital,International University of Helth and Welfare, Center for Cancer Ablation Therapy, Tokyo, Japan.
²⁶ Ultrasound Section, Division of Surgery, Dep. of Gastroenterology, Herlev Hospital Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Denmark.
²⁷ Div. Internal Medicine, Dept of Medical and Surgical Sciences, Bologna, Italy.
²⁸ P.Stradina Clinical University Hospital, Diagnosic Radiology Institute, Riga, Latvia.
²⁹ Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
³⁰ King's College London, Radiology, London, United Kingdom of Great Britain and Northern Ireland.
³¹ Gastroenterology, University of Medicine and Pharmacy Timisoara, Timisoara, Romania.
³² Cariats-Krankenhaus Bad Mergentheim, Pediatrics, Bad Mergentheim, Germany.
³³ Liver Imaging Grup, University of California, Department of Radiology, San Diego, United States.
³⁴ Klinikum Siloah, Ultrasound Outpatient Department, Hannover, Germany.
³⁵ Department of Radiology, Foothills Medical Centre University of Calgary, Division of Ultrasound, Calgary, Canada.
³⁶ Department of Radiology, Stanford University, Stanford, United States.
³⁷ Department of Medical Imaging, University of Toronto, Toronto, Canada.
³⁸ Radiology, University of California, San Diego, United States.
³⁹ Ultrasound, Charles Sturt University NSW Australia, NSW, Australia.

PMID: 29423461
PMCID: PMC5802984
DOI: 10.1055/s-0043-123931

Review

How to perform Contrast-Enhanced Ultrasound (CEUS)

Christoph F Dietrich et al. Ultrasound Int Open. 2018 Jan.

. 2018 Jan;4(1):E2-E15.

doi: 10.1055/s-0043-123931. Epub 2018 Feb 7.

Authors

Affiliations

¹ Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany and Ultrasound Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Bioengineering, University of Washington, Seattle, United States.
³ Rigshospitalet, Dep. of Radiology, Copenhagen, Denmark.
⁴ Radiology, Northeastern Ohio Medical University, Rootstown, United States.
⁵ Dept Medical Biophysics, University of Toronto. Sunnybrook Research Institute, Toronto, Canada.
⁶ Policlinico San Matteo, University of Pavia, Department of Radiology, Pavia, Italy.
⁷ Department of Radiology, "Sapienza" University of Rome, ROME, Italy.
⁸ Department of Radiology, Chung-Ang University Hosptial, Seoul, Korea (the Republic of).
⁹ Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil.
¹⁰ Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany.
¹¹ Department of Pediatric Radiology, Centre Hospitalier Universitaire de Nancy and Université de Lorraine, Vandoeuvre, France.
¹² Hopital universitaire Necker-Enfants malades, Service de Radiologie Adultes, Paris, France.
¹³ Department of Medical Ultrasound, Tongji Hospital of Tongji Medical college, Huahzong University of Science and technology, Wuhan, China.
¹⁴ Imperial College London, Imaging, London, United Kingdom of Great Britain and Northern Ireland.
¹⁵ Radiology, University of Verona, Verona, Italy.
¹⁶ Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
¹⁷ Department of Radiology, Thomas Jefferson University, Philadelphia, United States.
¹⁸ Radiology, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain.
¹⁹ National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway.
²⁰ Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany.
²¹ Department of Medicine and Radiology, University of California, San Diego, United States.
²² Kinki Daigaku Igakubu, Department Gastroenterology and Hepatology, Osakasayama, Osaka, Japan.
²³ Gustave Roussy and IR4MUMR8081. Université Paris-Sud, Université Paris-Saclay, Radiology, Paris, France.
²⁴ Radiology Department of Interventional Ultrasound - Casa di cura Igea- Milano, Italy.
²⁵ Sanno Hospital,International University of Helth and Welfare, Center for Cancer Ablation Therapy, Tokyo, Japan.
²⁶ Ultrasound Section, Division of Surgery, Dep. of Gastroenterology, Herlev Hospital Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Denmark.
²⁷ Div. Internal Medicine, Dept of Medical and Surgical Sciences, Bologna, Italy.
²⁸ P.Stradina Clinical University Hospital, Diagnosic Radiology Institute, Riga, Latvia.
²⁹ Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
³⁰ King's College London, Radiology, London, United Kingdom of Great Britain and Northern Ireland.
³¹ Gastroenterology, University of Medicine and Pharmacy Timisoara, Timisoara, Romania.
³² Cariats-Krankenhaus Bad Mergentheim, Pediatrics, Bad Mergentheim, Germany.
³³ Liver Imaging Grup, University of California, Department of Radiology, San Diego, United States.
³⁴ Klinikum Siloah, Ultrasound Outpatient Department, Hannover, Germany.
³⁵ Department of Radiology, Foothills Medical Centre University of Calgary, Division of Ultrasound, Calgary, Canada.
³⁶ Department of Radiology, Stanford University, Stanford, United States.
³⁷ Department of Medical Imaging, University of Toronto, Toronto, Canada.
³⁸ Radiology, University of California, San Diego, United States.
³⁹ Ultrasound, Charles Sturt University NSW Australia, NSW, Australia.

PMID: 29423461
PMCID: PMC5802984
DOI: 10.1055/s-0043-123931

Abstract

"How to perform contrast-enhanced ultrasound (CEUS)" provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for optimal CEUS performance. CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience. The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.

Keywords: cancer; guidelines; teaching; ultrasonography.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Some authors declare conflicts of interest, which are available by the publisher and as supplemetary file.

Figures

**Fig. 1**
Malignant focal liver lesions in healthy liver parenchyma show a variable arterial enhancement pattern according to their etiology (rim enhancement in the case of some metastases a and as decisive criteria hypoenhancement in the portal venous (sinusoidal and “liver specific”) phase in comparison to the surrounding liver parenchyma b .

**Fig. 2**
Benign focal liver lesions in healthy liver parenchyma show a variable arterial enhancement pattern according to their etiology a and as decisive criteria iso- or hyper-enhancement in the portal venous (sinusoidal and “liver specific”) phase in comparison to the surrounding liver parenchyma b .

**Fig. 3**
Time-intensity curve for a bolus injection in a tissue mimicking flow phantom. A lognormal curve (solid line) is fitted to the data and it is used to calculate the important quantification parameters (44) (PI, RT, MTT, and AUC).

**Fig. 4**
Low gain setting results in underestimation of the microbubbles located in the microcirculation ( a ). The proper gain setting results in a correct display of microbubbles in both micro- and macrovessels ( b ). High gain results in signal oversaturation and the image is too bright making the distinction between macro and micro-vasculature more difficult ( c ).

See this image and copyright information in PMC

References

1. Albrecht T, Blomley M, Bolondi L, Claudon M, Correas J M, Cosgrove D, Greiner L et al.Guidelines for the use of contrast agents in ultrasound. January 2004. Ultraschall Med. 2004;25:249–256. - PubMed
1. Claudon M, Cosgrove D, Albrecht T, Bolondi L, Bosio M, Calliada F, Correas J M et al.Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) - Update 2008. Ultraschall Med. 2008;29:28–44. - PubMed
1. Piscaglia F, Nolsoe C, Dietrich C F, Cosgrove D O, Gilja O H, Bachmann N M, Albrecht T et al.The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): Update 2011 on non-hepatic applications. Ultraschall Med. 2012;33:33–59. - PubMed
1. Claudon M, Dietrich C F, Choi B I, Cosgrove D O, Kudo M, Nolsoe C P, Piscaglia F et al.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. Ultraschall Med. 2013;34:11–29. - PubMed
1. Claudon M, Dietrich C F, Choi B I, Cosgrove D O, Kudo M, Nolsoe C P, Piscaglia F et al.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. Ultrasound Med Biol. 2013;39:187–210. - PubMed

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How to perform Contrast-Enhanced Ultrasound (CEUS)

Affiliations

How to perform Contrast-Enhanced Ultrasound (CEUS)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

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