The EFSUMB Guidelines and Recommendations on the Clinical Practic of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications
The EFSUMB Guidelines and Recommendations on the Clinical Practic of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications
复制标题
DOI：
10.1055/s-0031-1281676
复制
发表时间：
2012-02-01
影响因子：
3.4
通讯作者：
Weskott, H. P.
中科院分区：
文献类型：
--
作者：
Piscaglia, F.;Nolsoe, C.;Weskott, H. P.
本世纪初，首次发表了关于超声造影剂（UCA）与造影剂特异性成像技术的临床应用的研究，使用Levovist®作为UCA [1，2]。几年后，六氟化硫（Sono-Vue®，米兰Brasserie）在欧洲上市，开启了真实的时间低机械指数（MI）对比增强超声（CEUS）时代。欧洲医学和生物学超声学会联合会（EFSUMB）于2004年发布了第一个CEUS使用指南[3]。该文件主要关注肝脏应用，促进了CEUS的快速扩展，并批准了首字母缩写“CEUS”。CEUS被认为是一项革命性的技术，在接下来的几年里，除了肝脏的应用外，还开发了许多新的应用。因此，在EFSUMB于2008年发布的关于使用CEUS的临床建议更新中[4]，描述了在其他一些器官中的应用。从那时起，人们对CEUS临床应用的兴趣呈指数级增长，并对新领域进行了研究，因此现在几乎所有器官系统都进行了某种CEUS研究。截至2010年底，在PubMed®中检索到的约900篇原始研究性文章（不包括社论和信件）中，超过一半是在EFSUMB指南最后一次更新后的2008年之后发表的[4]。因此，2010年，EFSUMB认为现在是开始编写新的《准则》更新版的适当时机。鉴于CEUS使用的扩展，认为如果在全球范围内获得批准，对肝脏应用的CEUS进行新的更新将对临床社区更有益。因此，与世界医学和生物学超声学会联合会（WFUMB）达成协议，利用其先前的经验和先前发表的文件[4]，与EFSUMB专门针对肝脏应用制定联合指南。预计这些将在Ultraschall in der Medizin/European Journal of Ultrasound和Ultrasound in Medicine and Biology上同时发表。与此同时，EFSUMB执行局决定，在指导委员会的指导下，非肝脏应用将由专门的ESFUMB文件涵盖。指导委员会根据作者在各个感兴趣领域的出版记录以及他们作为研究和教学CEUS国际专家的声誉选择了一个作者小组。出于必要，该共同作者名单可能仅包括有限数量的人员，我们承认许多其他高素质的CEUS操作员在整个欧洲都很活跃，并发表了关于不同CEUS主题的有价值的科学文章。EFSUMB对未能将所有人都纳入这一进程表示遗憾。这些关于使用CEUS的临床建议基于全面的文献调查，包括前瞻性临床试验的结果。对于没有或几乎没有重要研究数据的主题，证据来自专家委员会报告或基于2011年4月在法兰克福举行的共识会议期间该领域专家的观点。与以前的版本一样，这些建议为使用UCA提供了一般性建议。它们旨在为UCA的使用和管理创建标准协议，并改善患者管理。个别病例必须根据该特定患者的所有临床资料进行处理。
The first studies on the clinical use of ultrasound contrast agents (UCAs) with contrast specific imaging techniques were published at the beginning of this century using Levovist® as UCA [1, 2]. A couple of years later sulphur hexafluoride (Sono-Vue®, Bracco, Milan) was marketed in Europe, opening the era of real time low mechanical index (MI) contrast enhanced ultrasound (CEUS). The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) released the first Guidelines on the use of CEUS in 2004 [3]. This document, which focused mainly on liver applications, contributed to the rapid expansion of CEUS and sanctioned the acronym “CEUS”. CEUS was felt to be a revolutionary technique and many new applications, besides those in the liver, were developed in the following years. Therefore, in the update of the Clinical Recommendations on the use of CEUS by the EFSUMB, published in 2008 [4], applications in some other organs were described. Since then, there has been exponentially increasing interest in the clinical applications of CEUS and new fields have been investigated, so that nearly all organ systems have now been subjected to some kind of CEUS study. More than half of the approximately 900 original investigative articles (editorials and letters excluded) found in PubMed® under the search term “Contrast Enhanced Ultrasound” by the end of 2010 were published after 2008, after the last update of the EFSUMB guidelines [4]. Therefore, in 2010 EFSUMB felt it was the right time to start preparing a new update of the Guidelines. In the light of the expansion in CEUS usage, it was felt that a new update on CEUS for liver applications would be more beneficial to the clinical community if endorsed on a worldwide basis. Therefore, an agreement was reached with the World Federation of Societies for Ultrasound in Medicine and Biology (WFUMB) to prepare joint guidelines with EFSUMB exclusively for liver applications, taking advantage of its previous experience and of the previously published document [4]. These are expected to be issued as double simultaneous publications in Ultraschall in der Medizin/European Journal of Ultrasound and in Ultrasound in Medicine and Biology. At the same time the EFSUMB Executive Bureau decided that non-liver applications would be covered by a dedicated ESFUMB document under the guidance of a steering committee. The steering committee chose a panel of authors on the basis of their publication records in the various fields of interest and their reputation as international experts in research and teaching CEUS. By necessity, this list of co-authors could include only a limited number of persons and we acknowledge that many other highly qualified CEUS operators are active throughout Europe and have published valuable scientific articles on different CEUS topics. EFSUMB regrets not being able to include all of them in this process. These Clinical Recommendations on the use of CEUS are based on comprehensive literature surveys including results from prospective clinical trials. In the case of topics for which no or little significant study data were available, evidence was obtained from expert committee reports or was based on the views of experts in the field during a consensus conference held in Frankfurt in April 2011. As with the previous editions, these recommendations provide general advice for the use of UCAs. They are intended to create standard protocols for the use and administration of UCAs and improve the patient management. Individual cases must be managed on the basis of all clinical data available for that specific patient.A few points are worth special …