Ultraschall in Med 2017; 38(04): e16-e47
DOI: 10.1055/s-0043-103952
Guidelines & Recommendations
© Georg Thieme Verlag KG Stuttgart · New York

EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version)

EFSUMB-Leitlinien und Empfehlungen zur klinischen Anwendung der Leberelastographie, Update 2017 (Langversion)Christoph F. Dietrich1, 2, Jeffrey Bamber3, Annalisa Berzigotti4, Simona Bota5, Vito Cantisani6, Laurent Castera7, David Cosgrove8, Giovanna Ferraioli9, Mireen Friedrich-Rust10, Odd Helge Gilja11, Ruediger Stephan Goertz12, Thomas Karlas13, Robert de Knegt14, Victor de Ledinghen15, Fabio Piscaglia16, Bogdan Procopet17, Adrian Saftoiu18, Paul S. Sidhu19, Ioan Sporea20, Maja Thiele21
  • 1Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
  • 2Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
  • 3Joint Department of Physics and the CRUK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 15 Cotswold Road, Sutton, London, SM2 5NG, UK
  • 4Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
  • 5Department of Gastroenterology, Hepatology, Nephrology and Endocrinology, Klinikum Klagenfurt, Klagenfurt am Wörthersee, Austria
  • 6Department of Radiological Sciences, Policlinico Umberto I, University Sapienza, Rome, Italy
  • 7Department of Hepatology, Hopital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris VII, INSERM UMR 1149, Clichy, France
  • 8Imaging Departments, Imperial and King’s Colleges, London, UM, UK
  • 9Infectious Diseases Dept, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
  • 10Department of Internal Medicine 1, J. W.Goethe-University Hospital, Frankfurt, Germany
  • 11National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
  • 12Department of Internal Medicine 1 – Gastroenterology, Pneumology and Endocrinology, University of Erlangen-Nürnberg, Erlangen, Germany
  • 13Department for Internal Medicine, Division of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
  • 14Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
  • 15Non-invasive diagnosis of liver fibrosis centre, Haut-Leveque hospital, Bordeaux University Hospital, Pessac, France
  • 16Unit of Internal Medicine, Dpt of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
  • 17Department of Gastroenterology, 3rd Medical Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”. Regional Institut of Gastroenterology and Hepatology “O. Fodor”, Cluj-Napoca, Romania
  • 18Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
  • 19King’s College London, Department of Radiology, King’s College Hospital, London
  • 20Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
  • 21Department of Gastroenterology and Hepatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
Further Information

Publication History

03 January 2017

02 February 2017

Publication Date:
13 April 2017 (eFirst)

Abstract

We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography, focused on the assessment of diffuse liver disease. The first part (long version) of these Guidelines and Recommendations deals with the basic principles of elastography and provides an update of how the technology has changed. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided regarding optimization of scanning technique, image display, image interpretation, reporting of data and some of the known image artefacts. The second part provides clinical information about the practical use of elastography equipment and the interpretation of results in the assessment of diffuse liver disease and analyzes the main findings based on published studies, stressing the evidence from meta-analyses. The role of elastography in different etiologies of liver disease and in several clinical scenarios is also discussed. All of the recommendations are judged with regard to their evidence-based strength according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both beginners and advanced clinical users.

Zusammenfassung

Dies ist die erste Überarbeitung der 2013 publizierten EFSUMB-Leitlinien zur klinischen Anwendung der Elastographie und konzentriert sich auf die diffusen Lebererkrankungen. Der erste Teil dieser Leitlinien und Empfehlungen handelt von den Grundlagen der Elastografie und erläutert die Weiterentwicklungen der Technologie während dieses Zeitraumes. Die praktischen Vor- und Nachteile der verschiedenen Techniken werden beschrieben. Auch die Optimierung der Untersuchungstechnik, Bilddarstellung, Bildinterpretation und die Befundbeschreibung sowie Artefakte werden dargelegt. Der klinische Teil dieser Leitlinien erläutert die praktische Anwendung der Elastografie bei der Beurteilung diffuser Lebererkrankungen unter Berücksichtigung der Geräteausstattung und Interpretation der Ergebnisse. Die aktuelle Literatur wurde analysiert unter besonderer Beachtung von Metaanalysen. Die klinische Anwendung der Elastografie wird unter Reflexion unterschiedlicher klinischer Szenarien und der unterschiedlichen Ätiologien diffuser Lebererkrankungen erläutert. Alle Empfehlungen erfolgten gemäß der Evidenz basierten Methodik der Oxford-Klassifikation. Das hier vorgestellte Update soll dem Anfänger und fortgeschrittenen Nutzer eine praktische Hilfe darstellen.