MPUS is a big step forward for small organs

Multiparametric imaging combines the information from different functional imaging sequences or techniques and is best known from multiparametric MRI in which the information of a number of different sequences is used to investigate lesions. By combining the analysis of several structural and functional tissue properties, the characterization of lesions is much more precise than by just relying on one sequence or technique only. In fact, the combination of the variety of MRI imaging procedures and sequences as a “one-shop” procedure resulted in the term “multiparametric”. Multiparametric MRI is used in daily clinical practice in neuroimaging, liver imaging, musculoskeletal imaging, breast imaging, prostate imaging, etc. The term ‘multiparametric’ can also be applied to computed tomography (CT) as it allows functional imaging, 3D-reconstruction and imaging at different phases after contrast administration. CT has improved the visualization of the chest, pleural and abdominal cavity and revolutionized trauma management and plays a fundamental role in the diagnosis of the acute abdomen. Despite the undisputed strengths of MRI and CT, limitations are obvious: radiation exposure, foreign bodies with contraindication for MRI, patient movement with and without injection of contrast media, high cost and limitations of availability and, above all, impossibity to us CT and MRI on the bedside and directly “at the point of need”, claustrophobia in a significant proportion of patients, sedation in pediatric use and others [1] [2]. In recent decades, ultrasound imaging has also outgrown the one-dimensionality of A-Mode and the frequency-dependent high-resolution visualization of morphological details in B-Mode in several ways: functional processes can be mapped in real time, structural details displayed in 4 D, and the interaction of structures with the propagation characteristics of sound waves can be used for qualitative and quantitative analysis of tissue elasticity in strain and shear wave elastography, fat infiltration on attenuation imaging and potentially necro-inflammation using shear wave dispersion. Doppler techniques and contrast-enhanced techniques quantitatively capture blood flow, vascular density and vascularization patterns in lesions and their surroundings in real-time – with the highest temporal and spatial resolution [3] [4] [5] [6]. This multitude of information on tissue properties is achieved with lower costs and lower patient morbidity than by any other imaging modality. In fact, since the first use of the term ‘multiparametric ultrasound’ (MPUS) [7], years by years more popularity was gained in literature and among scientific societies active in the field of medical imaging on its use to describe modern ultrasound imaging, combining various technologies to precisely characterize focal lesions and their interaction with surrounding parenchyma and combining a multitude of structural and functional tissue features, perhaps similar to the terminology used in MRI [8]. Since its foundation, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has established a strong tradition of supporting good clinical practice and in promoting evidence-based medicine [9] [10]. Considering the high clinical utility of those newer ultrasound techniques, EFSUMB has published several clinical guidelines, technical reviews, and position papers on many areas of medical ultrasound including CEUS [11] [12] [13] [14], the analysis of time intensity curves [15], elastographic techniques [5] [6], but also in interventional ultrasound [16] [17] [18] [19] [20] [21] [22] [23] [24] and gastrointestinal ultrasound [25] [26] [27] [28] [29] [30]. In light of the increasing number of publications and the need to analyse benefits and limitations, as well as to standardize the use of multiparametric ultrasound (MPUS), EFSUMB has decided to launch the first MPUS guidelines for “small parts” (thyroid, testis, breast) and to proceed with guidelines on the pancreatic application of MPUS. Guidelines on the application of MPUS to the liver have already been published by the World Federation for Ultrasound in Medicine and Biology (WFUMB) in close cooperation with EFSUMB [31] [32].

Publication History

Article published online:
05 February 2025

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