EFSUMB Technical Review – Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion

Christoph F. Dietrich; Jean-Michel Correas; Xin-Wu Cui; Yi Dong; Roald Flesland Havre; Christian Jenssen; Ernst Michael Jung; Martin Krix; Adrian Lim; Nathalie Lassau; Fabio Piscaglia

doi:10.1055/a-2157-2587

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2024; 45(01): 36-46
DOI: 10.1055/a-2157-2587

Guidelines & Recommendations

EFSUMB Technical Review – Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion

Technisches Review der EFSUMB – Update 2023: Dynamischer kontrastverstärkter Ultraschall (DCE-US) zur Quantifizierung der Tumorperfusion

Authors

Christoph F. Dietrich

¹Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland

²Zentrum der Inneren Medizin, Johann Wolfgang Goethe Universitätsklinik Frankfurt, Frankfurt, Germany
Jean-Michel Correas

³Department of Adult Radiology, Assistance Publique Hôpitaux de Paris, Necker University Hospital, Paris, France

⁴Paris Cité University, Paris, France

⁵CNRS, INSERM Laboratoire d’Imagerie Biomédicale, Sorbonne Université, Paris, France
Xin-Wu Cui

⁶Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Yi Dong

⁷Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Ringgold ID: RIN91603)
Roald Flesland Havre

⁸Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway

⁹Department of Clinical Medicine, University of Bergen, Bergen, Norway
Christian Jenssen

¹⁰Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Wriezen, Germany

¹¹Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, Neuruppin, Brandenburg, Germany
Ernst Michael Jung

¹²Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
Martin Krix

¹³Global Medical & Regulatory Affairs, Bracco Imaging, Konstanz, Germany
Adrian Lim

¹⁴Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
Nathalie Lassau

¹⁵Imaging Department. Gustave Roussy cancer Campus. Villejuif, France. BIOMAPS. UMR 1281. CEA. CNRS. INSERM, Université Paris-Saclay, France
Fabio Piscaglia

¹⁶Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

¹⁷Dept of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

Abstract

Dynamic contrast-enhanced ultrasound (DCE-US) is a technique to quantify tissue perfusion based on phase-specific enhancement after the injection of microbubble contrast agents for diagnostic ultrasound. The guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published in 2004 and updated in 2008, 2011, and 2020 focused on the use of contrast-enhanced ultrasound (CEUS), including essential technical requirements, training, investigational procedures and steps, guidance regarding image interpretation, established and recommended clinical indications, and safety considerations. However, the quantification of phase-specific enhancement patterns acquired with ultrasound contrast agents (UCAs) is not discussed here. The purpose of this EFSUMB Technical Review is to further establish a basis for the standardization of DCE-US focusing on treatment monitoring in oncology. It provides some recommendations and descriptions as to how to quantify dynamic ultrasound contrast enhancement, and technical explanations for the analysis of time-intensity curves (TICs). This update of the 2012 EFSUMB introduction to DCE-US includes clinical aspects for data collection, analysis, and interpretation that have emerged from recent studies. The current study not only aims to support future work in this research field but also to facilitate a transition to clinical routine use of DCE-US.

Zusammenfassung

Der DCE-US (Dynamic contrast-enhanced ultrasound) ist eine Quantifizierungstechnik des kontrastverstärkten Ultraschalls. Die EFSUMB-Leitlinien von 2004, mit Updates aus den Jahren 2008, 2011, 2013 und 2020, erläutern die Grundlagen der Ultraschall-Kontrastmitteltechniken, geben aber keine detaillierten Informationen zu den Anwendungsmöglichkeiten, der Vorgehensweise und den Besonderheiten des DCE-US. Ziel dieses EFSUMB-Dokuments ist es nun, auf der Basis einer aktuellen Literaturrecherche Standardisierungsgrundlagen zur Methodik des DCE-US – insbesondere für das Therapiemonitoring bei onkologischen Erkrankungen – weiter zu vertiefen. Die notwendigen Grundlagen und technischen Voraussetzungen für die Analyse von Zeit-Intensitätskurven werden vorgestellt. Das vorliegende Update eines EFSUMB-Statements aus dem Jahr 2012 berücksichtigt klinische Aspekte aufgrund jüngster Studien für einen standardisierten Ablauf der Daten-Akquise und -Analyse sowie Empfehlungen zur Interpretation. Die aktuelle Arbeit zielt nicht nur darauf ab, künftige Arbeiten auf diesem Forschungsgebiet zu unterstützen, sondern auch den Übergang zur klinischen Routineanwendung des DCE-US zu erleichtern.

Keywords

contrast-enhanced ultrasound - guidelines - quantification - therapy monitoring - tumor perfusion

Full Text

References

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