European Federation Of Societies For Ultrasound In Medicine And Biology Guidelines Research Articles

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018

This manuscript describes the use of ultrasound elastography, with the exception of liver applications, and represents an update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography.

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

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.

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

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 with a focus on the assessment of diffuse liver disease. The short version provides clinical information about the practical use of elastography equipment and 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.

Shear Wave Elastography in Children

Most recently the update on the 2013 published European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines and Recommendations on the clinical use of elastography have been published focusing on the assessment of diffuse liver disease (1, 2). The first part of the long version of these EFSUMB Guidelines deals with the basic principles of elastography including the reasons why ultrasound can be used to make elastograms. Transient elastography (TE) is explained as shear wave elastometry by measurement of the speed of a shear wave that has been generated using a surface impulse. Point shear wave elastography (pSWE) is explained as shear wave elastometry at a location by measurement of the speed of a shear wave generated using acoustic radiation force. Multidimensional shear-wave elastography (2D-SWE, 3D-SWE) is described as quantitative SWE imaging (and elastometry) by measuring the speed of shear waves generated using acoustic radiation force. Acoustic radiation force impulse (ARFI) imaging is discussed as well (1, 2). Guidance is provided on optimization of scanning technique, image display, image interpretation, reporting of data and some of the known image artefacts. The second and clinical part provides clinical information about the practical use of elastography equipment and interpretation of results in the assessment of different etiologies of diffuse liver disease including normal values and reliability indices (1-4). Comparative little is known about pediatric patients. Data regarding the pediatric population with biliary atresia suggest that liver (and spleen) elastography could be a valuable tool to predict outcomes before surgery, and might be used after the Kasai operation to monitor liver disease and portal hypertension [(5)]. Many other indications have been shown of value in daily practice but comparative studies are lacking. Here we present the current knowledge and our own data on the use of elastography in pediatric patients including the use of strain elastography (SE) and strain-rate imaging (quasi-static strain imaging). Future perspectives of this promising method are discussed as well. 1. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall Med 2017. 2. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version). Ultraschall Med 2017. 3. Dong Y, Sirli R, Ferraioli G, Sporea I, Chiorean L, Cui X, Fan M, et al. Shear wave elastography of the liver - review on normal values. Z Gastroenterol 2017;55:153-166. 4. Dietrich CF, Dong Y. Shear wave elastography with a new reliability indicator. J Ultrason 2016;16:281-287. 5. Colecchia A, Di Biase AR, Scaioli E, Predieri B, Iughetti L, Reggiani ML, Montrone L, et al. Non-invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure. Dig Liver Dis 2011;43:659-663.

Elastography Guidelines for the Assessment of Diffuse Liver Disease

Guidelines for the use of elastography have been produced by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the World Federation for Ultrasound in Medicine and Biology (WFUMB), as well as by clinical associations, including the European Association for Study of Liver (EASL) together with the Asociacion Latinoamericana para el Estudio del Higado (ALEH), the Asian Pacific Association for the Study of the Liver (APASL), and the American Gastroenterological Association (AGA). The guidelines produced by these clinical associations are focused on the assessment of diffuse liver disease. Moreover, the Society of Radiologists in Ultrasound (SRU) in the United States has released a consensus statement on the use of elastography in diffuse liver disease. The amount of elastography guidelines that have been issued witnesses the great interest for the use of the available techniques in several clinical settings. EFSUMB has recently produced an update of the previously published guidelines that is dedicated to the assessment of diffuse liver disease but also provides an update of the basic principles where the technology has changed. The EFSUMB and WFUMB guidelines, as well as the SRU consensus statement, describe the advantages and disadvantages associated with the use of each elastography technique and provide a practical guide for both beginners and expert users. The role of elastography in different diseases and in several clinical scenarios is analyzed.

Comments and extensions to EFSUMB guidelines on renal interventional ultrasound (INVUS).

The substantial evidence base for interventional ultrasound approaches to renal diagnostic sampling and therapeutic access exists. This review comments on the evidence-based recommendations on ultrasound-guided renal access which have been published recently within the framework of Guidelines on Interventional Ultrasound (InVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) from a clinical practice point of view. Specific aspects of tissue handling and workup, procedural approach and patient interaction are discussed. Indications, contraindications, risk factors and methods to reduce these risks are considered.

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V - EUS-Guided Therapeutic Interventions (short version).

The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation (short version; the long version is published online).

US-guided peripheral vascular interventions, comments on the EFSUMB guidelines

Peripheral venous as well as arterial punctures have traditionally been performed on the basis of designated anatomical landmarks. However, due to patients' individual anatomy and vessel pathology and depending on individual operators' skill, this landmark approach is associated with a significant failure rate and complication risk. This review comments on the evidence-based recommendations on ultrasound (US)-guided vascular access which have been published recently within the framework of Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for US in Medicine and Biology (EFSUMB) from a clinical practice point of view. Part 1 of the review had its focus on general aspects of US- guidance and on central venous access, whereas part 2 refers to peripheral vascular access.

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV - EUS-guided interventions: General Aspects and EUS-guided Sampling (Short Version).

The fourth part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound describes general aspects of endoscopic ultrasound-guided diagnostic and therapeutic interventions and assesses the evidence for endoscopic ultrasound-guided sampling. Endoscopic ultrasound combines the most advanced high-resolution ultrasound imaging of lesions within the wall and in the vicinity of the gastrointestinal tract and safe and effective fine needle-based tissue acquisition from these lesions. The guideline addresses the indications, contraindications, techniques, adverse events, training and clinical impact of EUS-guided sampling. Advantages and drawbacks are weighed in comparison with image-guided percutaneous biopsy. Based on the most current evidence, clinical practice recommendations are given for crucial preconditions and steps of EUS-guided sampling as well as for safe performance. Additionally, the guideline deals with the principles and reliability of cytopathological reporting in endoscopic ultrasound-guided sampling (short version; the long version is published online).

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III - Abdominal Treatment Procedures (Short Version).

The third part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound assesses the evidence for ultrasound-guided and assisted interventions in abdominal treatment procedures. Recommendations for clinical practice are presented covering indications, contraindications, safety and efficacy of the broad variety of these techniques. In particular, drainage of abscesses and fluid collections, interventional tumor ablation techniques, interventional treatment of symptomatic cysts and echinococcosis, percutaneous transhepatic cholangiography and drainage, percutaneous gastrostomy, urinary bladder drainage, and nephrostomy are addressed (short version; a long version is published online).

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III - Abdominal Treatment Procedures (Long Version).

The third part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound (INVUS) assesses the evidence for ultrasound-guided and assisted interventions in abdominal treatment procedures. Recommendations for clinical practice are presented covering indications, contraindications, and safe and effective performance of the broad variety of these techniques. In particular, drainage of abscesses and fluid collections, interventional tumor ablation techniques, interventional treatment of symptomatic cysts and echinococcosis, percutaneous transhepatic cholangiography and drainage, percutaneous gastrostomy, urinary bladder drainage, and nephrostomy are addressed (long version).

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V.

The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation in clinical practice (long version).

EFSUMB guidelines 2015 on interventional ultrasound.

Ultrasound-guided interventions have revolutionized the everyday clinical practice during recent decades. The new interventional ultrasound (INVUS) guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) are an expression of interdisciplinary and multiprofessional viewpoints, some of which represent different approaches; this reflects reality in all its diversity. Particular attention has been given to clinical significance including the level of evidence and the more practical grade of recommendation. The review refers to the history of interventional ultrasound and comments on the current EFSUMB guidelines.

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part VI - Ultrasound-Guided Vascular Interventions.

The sixth part of the Guidelines on Interventional Ultrasound produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for ultrasound guidance and assistance in vascular interventions. Based on convincing data, real-time sonographic guidance for central venous access is strongly recommended as a key safety measure. Systematic analysis of scientific literature shows that in difficult situations and special circumstances US guidance may also improve the efficacy and safety of peripheral venous and arterial access and endovascular interventions. Moreover, the recommendations of this guideline endorse the use of ultrasound to detect complications of vascular access and US-guidedinterventional treatment of arterial pseudoaneurysms.

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV - EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version).

The fourth part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound describes general aspects of endoscopic ultrasound-guided diagnostic and therapeutic interventions and assesses the evidence for endoscopic ultrasound-guided sampling. Endoscopic ultrasound combines the most advanced high-resolution ultrasound imaging of lesions within the wall and in the vicinity of the gastrointestinal tract and safe and effective fine needle based tissue acquisition from these lesions. The guideline addresses the indications, contraindications, techniques, adverse events, training and clinical impact of EUS-guided sampling. Advantages and drawbacks are weighed in comparison with image-guided percutaneous biopsy. Based on the most current evidence, clinical practice recommendations are given for crucial preconditions and steps of EUS-guided sampling as well as for safe performance. Additionally, the guideline deals with the principles and reliability of cytopathological reporting in endoscopic ultrasound-guided sampling (long version).

Actualización del uso de contrastes en ecografía. Revisión de las guías clínicas de la Federación Europea de Ecografía (EFSUMB)

The aim of this article is to review the current indications for the use of contrast agents in ultrasonography in imaging departments with reference to the guidelines and recommendations recently published by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The article begins with a brief description of currently available contrast agents, of their adverse effects and contraindications, and of the specific techniques that enable the signal emitted from the microbubbles in the contrast to be detected. Next, we review the indications for ultrasound contrast agents both in the liver (detecting and characterizing focal lesions as well as guiding and monitoring percutaneous treatments) and outside the liver (in the kidney, vesicoureteral reflux, pancreas, traumatisms, and cerebral circulation). For each of the indications, first we describe the interpretation of the findings, then the recommended uses, and finally the limitations of the technique. Finally, we review all the other applications that have yet to be included in the EFSUMB guidelines.

Impact of European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines on the use of contrast agents in liver ultrasound

The introduction of microbubble contrast agents and the development of contrast-specific techniques have opened new prospects in liver ultrasound. Over the past few years several reports have shown that contrast ultrasound can substantially improve detection and characterization of focal liver lesions with respect to baseline studies. The advent of second-generation agents and low mechanical index real-time scanning techniques has been instrumental in improving the easiness and the reproducibility of the examination. With the publication of the guidelines for the use of contrast agents in liver ultrasound by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), contrast ultrasound enters into clinical practice. The guidelines define the indications and recommendations for the use of contrast ultrasound in focal liver lesion detection, characterization, and follow-up after tumor ablation procedures. We discuss the impact of EFSUMB guidelines on diagnostic protocols currently adopted in liver imaging.

European federation of societies for ultrasound in medicine and biology (EFSUMB) guidelines for the use of contrast agents in liver ultrasound: what is the impact in clinical practice?

Ultrasound is the most commonly used liver imaging modality worldwide. Unfortunately, ultrasound has limited sensitivity in the detection of small tumour nodules. Moreover, ultrasound findings are often non-specific, as there is enough variability and overlap in the appearance of benign and malignant liver lesions to make a definite distinction problematic. Recently, the introduction of microbubble contrast agents and the development of contrast-specific techniques have opened new prospects in liver ultrasound. The advent of second-generation agents that have higher harmonic emission capabilities has been instrumental in improving the easiness and the reproducibility of the examination. Over the past few years, several reports have shown that real-time contrast-enhanced ultrasound can substantially improve detection and characterization of focal liver lesions with respect to baseline studies. With the publication of the guidelines for the use of contrast agents in liver ultrasound by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), contrast-enhanced ultrasound has entered clinical practice. The guidelines define the indications and recommendations for the use of contrast agents in focal liver lesion detection, characterization and posttreatment follow-up. In this paper, we discuss the impact of EFSUMB guidelines on diagnostic protocols currently adopted in liver imaging with regard to four clinical scenarios: (1) characterization of focal liver lesions of incidental detection; (2) diagnosis of HCC in patients with cirrhosis; (3) detection of hepatic metastases in oncology patients; (4) guidance and assessment of the outcome of percutaneous tumour ablation procedures.