Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) - update 2008

Ultrasound (US) contrast agents (UCAs), in conjunction
with contrast specific imaging techniques,
are increasingly accepted in clinical use
for diagnostic imaging and post-interventional
workup in several organs. To those not intimately
involved in the field, the rapid advances in
technology and techniques can be difficult to
follow. In March of 2003, at the EUROSON Congress
in Copenhagen, it was agreed that it would
be useful to produce a document providing a
description of essential technical requirements,
proposed investigator qualifications, suggested
study procedures and steps, guidance on image
interpretation, recommended and established
clinical indications and safety considerations.
Initially a set of guidelines for the use of ultrasonic
contrast agents in the liver alone were
developed. These were presented and discussed
in detail at an EFSUMB special consensus meeting
held in Rotterdam in January 2004. The resulting
consensus document was published in
the August 2004 edition of Ultraschall in der
Medizin/European Journal of Ultrasound, and
has also been published in French [1] and Chinese
[2]. Time has however moved on, and EFSUMB
and the group of experts who developed
these first guidelines took the view in 2006
that they should be revisited and expanded to
include recommendations for applications in
the kidney, in vesico-ureteric reflux, in the pancreas,
in trauma and in the cerebral circulation.
In order to facilitate the production of these
new guidelines and recommendations a further
two meetings of experts were held, the first in
Bologna in September 2006 in conjunction with
the EUROSON/SIUMB meeting, the second immediately
following the European Symposium
on Ultrasonic Contrast Agent Imaging in Rotterdam
in January 2007.
As previously these guidelines are based on
comprehensive literature surveys including results
from prospective clinical trials. On issues
where no significant study data were available,
evidence was obtained from expert committee
reports or was based on the actual consensus
of experts in the field of US and contrast enhanced
Ultrasound (CEUS) during the consensus
conferences. During the meeting of experts
in Rotterdam many additional new and exciting
developments were discussed, and whilst some
are quickly entering clinical practice, it was felt
too early to include them in the current recommendations.
These guidelines and 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
management of patients. Individual cases must
be managed on the basis of all clinical data
available for that specific case. This second version
will be subject to change to reflect future
advances in scientific knowledge and the rapidly
evolving field of US technology.