Societies For Ultrasound In Medicine Research Articles

Primary liver tumours in childhood

The reported prevalence of focal liver lesions in adult patients and children is different. The article discusses pediatric liver tumors under the criteria of histopathology and contrast enhanced ultrasound (CEUS) features. Aim of this article is also to support the already established Pediatric Registry of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) to collect data on safety and applications of ultrasound contrast agents in children (www.efsumb.org).

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).

The Prospective External Validation of International Ovarian Tumor Analysis (IOTA) Simple Rules in the Hands of Level I and II Examiners.

Objective: To externally validate the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) by examiners with different levels of sonographic experience defined by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and to assess the morphological ultrasound features of the adnexal tumors classified as inconclusive based on IOTA SR. Materials and Methods: In the two-year prospective study adnexal tumors were assessed preoperatively with transvaginal ultrasound by examiners with different levels of experience (level 1- IOTA SR1, level 2-IOTA SR2). Additionally, an expert (level 3) evaluated all tumors by subjective assessment (SA). If the rules could not be applied, the tumors were considered inconclusive. The final diagnosis was based on the histopathological result of the removed mass. The diagnostic performance measures for the assessed model were sensitivity, specificity, negative (LR-) and positive(LR+) likelihood ratios, accuracy (ACC) and diagnostic odds ratio (DOR). Results: 226 women with adnexal tumors scheduled for surgery were included in the stutdy. The prevalence of malignancy was 36.3 % in the group of all studied tumors and was 52.5 % in the inconclusive group (n = 40) (p = 0.215). Fewer tumors were classified as inconclusive by level 2 examiners compared to level 1 examiners [20 (8.8 %) vs. 40 (17.7 %); p = 0.008], resulting from the discrepancy in the evaluation of acoustic shadows and the vascularization within the tumor. For level 1 examiners a diagnostic strategy using IOTA SR1 +MA (assuming malignancy when SR inconclusive) achieved a sensitivity, specificity and DOR of 96.3 %, 81.9 %, 13.624 respectively. For level 2 examiners the diagnostic strategy for IOTA SR2 +MA achieved a sensitivity, specificity and DOR of 95.1 %, 89.6 %, 137,143, respectively. Adding SA by an expert (or level 3 examiner) when IOTA SR were not applicable improved the specificity of the test and achieved a DOR of 505.137 (SR1 +SA) and 293.627 (SR2 +SA). The SA by an expert proved to have the best diagnostic performance with a DOR of 5768.857, and a sensitivity and specificity of 97.6 % and 99.3 % respectively. Within the inconclusive group the most common tumors were unilocular-solid (n-13), solid (n-8) and multilocular-solid (n-10) ones. All multilocular tumors were classified as inconclusive because of their size (≥ 100 mm) and were found to be benign by pathology. Most of the inconclusive tumors with cystic content presented low-level (43.75 %) echogenicity, followed by ground-glass (34.37 %), mixed (12.5 %) and anechoic (9.4 %). Conclusion: The study results show excellent diagnostic performance of IOTA Simple Rules followed by subjective expert assessment in inconclusive tumors irrespective of the level of experience, while subjective assessment by an expert still has the highest diagnostic odds ratio. The number of inconclusive cases seems to depend on the level of ultrasound expertise and less experienced examiners have a tendency to overestimate blood flow and a presence of acoustic shadows within the tumors. IOTA SR were not applicable either because no benign or malignant features were found or both were identified. Within inconclusive tumors the majority of cases comprise malignant masses that are either unilocular-solid, solid tumors or small multilocular-solid ones with a diameter of less than 100 mm.

Contrast enhanced ultrasound of renal masses. A reappraisal of EFSUMB recommendations and possible emerging applications.

The main imagistic method for characterization of renal lesions is contrast enhanced computed tomography (CECT). Disadvantages of CECT are a contrast-induced nephropathy in patients with renal impairment, allergic reactions and high costs. Contrast-enhanced ultrasound (CEUS) evaluation of hepatic and non-hepatic lesions is a relatively new, but increasingly utilised, diagnostic method. In 2011 the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) updated the Guidelines and Recommendations on the Clinical Practice of CEUS and included in the recommendation the renal pathology. However, there are several possible new indications that have not been discussed (pyelocaliceal masses and renal vein thrombosis) and several issues that remain controversial such as the differentiation of benign and malignant tumours or the differentiation of lymphoma and metastasis. This study aims to review literature data, as well as reveal the latest findings in the field of renal CEUS.

From SUMROC to CTSUM—A Brief History of Politics in Ultrasound

A brief history of the affiliation process of the ultrasound society of Taiwan to the Asian Federation of Societies for Ultrasound in Medicine and Biology and the World Federation for Ultrasound in Medicine and Biology is described. Although such an affiliation sounds very easy today, it required complicated and delicate negotiations and moderations in those difficult days (from 1986 to 1991). This was a typical past example of how politics was brought into the field of medical ultrasound. As some of the people involved have already passed away, a record of the hidden history might be needful and brought up from the viewpoint of the mediator.

2092035 How Useful Is Contrast Enhanced Ultrasound in the evaluation of Focal Liver Lesions. A Monocentric Experience

2092035 How Useful Is Contrast Enhanced Ultrasound in the evaluation of Focal Liver Lesions. A Monocentric Experience

Dynamic contrast-enhanced ultrasound for quantification of tissue perfusion.

Dynamic contrast-enhanced ultrasound (US) imaging, a technique that uses microbubble contrast agents with diagnostic US, has recently been technically summarized and reviewed by a European Federation of Societies for Ultrasound in Medicine and Biology position paper. However, the practical applications of this imaging technique were not included. This article reviews and discusses the published literature on the clinical use of dynamic contrast-enhanced US. This review finds that dynamic contrast-enhanced US imaging is the most sensitive cross-sectional real-time method for measuring the perfusion of parenchymatous organs noninvasively. It can measure parenchymal perfusion and therefore can differentiate between benign and malignant tumors. The most important routine clinical role of dynamic contrast-enhanced US is the prediction of tumor responses to chemotherapy within a very short time, shorter than using Response Evaluation Criteria in Solid Tumors criteria. Other applications found include quantifying the hepatic transit time, diabetic kidneys, transplant grafts, and Crohn disease. In addition, the problems involved in using dynamic contrast-enhanced US are discussed.

Current Role of Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma

The routine use of microbubble ultrasound contrast agents for studies of the liver has overcome several limitations of conventional B-mode and Doppler ultrasound techniques. Contrast-enhanced patterns of liver lesions can be studied during all vascular phases (arterial, portal venous, late phases), as in contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI). Furthermore, the use of contrastenhanced ultrasound (CEUS) to characterize focal lesions in cirrhosis has recently been recommended in the clinical practice guidelines issued by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). CEUS is a well-known, non-invasive technique that can be used to diagnose hepatocellular carcinoma (HCC) and can be performed in real time and under complete control of the ultrasound operator. In this review article, we summarize the basic concepts and techniques of CEUS, focusing on hepatic applications for the diagnosis of HCC. We also report the main guidelines regarding CEUS in the diagnosis of HCC, which have recently questioned its front-line role in clinical practice.

Echoscopy

The clinical use of pocket size ultrasound devices is still at an early stage. Its performance has been studied and proven in cardiology, gynecology, and gastroenterology. It is expected that the image quality will improve and that more techniques for miniaturized devices will be available in the near future. The perspective will be that more and more clinicians will have “echoscopes” as a bedside tool, replacing or complementary to a “stethoscope”. The term “echoscopy” was defined by the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB). Echoscopy is one form of point of care ultrasound (POCUS). Teaching material has been prepared by EFSUMB on how to use it (www.efsumb.org).

Contrast-enhanced ultrasound in liver cancer.

Contrast-enhanced ultrasound (CEUS) is a sure, noninvasive, repeatable imaging technique widely used in the characterization of benign and malignant liver lesions. The European Federation of Societies for Ultrasound in Medicine and Biology guidelines suggest the typical CEUS features of liver lesions as criteria for the noninvasive diagnosis in cirrhotic and not-cirrhotic patients. The clinical application of CEUS in the liver study is summarized in this review; the contrast-enhanced patterns of the most frequent liver lesions are described (hepatocellular and cholangiocellular carcinoma, liver metastases, hemangioma, focal nodular hyperplasia, adenoma). The role of this imaging technique in the diagnostic algorithm of liver malignancy is illustrated and the CEUS application in hepatologic and oncological settings is depicted.

ULTRASONOGRAPHY: on the way to becoming an internationally renowned journal.

After the founding of the Korean Society of Ultrasound in Medicine (KSUM) in 1980, a great deal of academic experience and knowledge had been accumulated, and the Journal of Korean Society of Ultrasound in Medicine was first published in December 1982 as an official scientific journal focused on medical ultrasound. Including the most recent five issues of Ultrasonography since January 2014, a total of 98 issues have been published up to the present. At the time of the first anniversary of the conversion from a domestic journal to an international open access journal published in English [1], on behalf of the editorial committee, I wish to express my appreciation to all the prior editors-in-chief for the early establishment and maintenance of a valuable tradition through this professional journal in medical ultrasound. During the first year of our journal, we made every effort to catch up with international standards and even lead the way. Ultrasonography has become indexed by PubMed Central and covered by PubMed (http://www.ncbi.nlm.nih.gov/pubmed?term=Ultrasonography[jour]) since July 2014, and full-text papers can be searched and freely downloaded from the earliest electronically published status, ahead of print. For identification of individual authors, the readers could access the ORCID (http://orcid.org/) identification of the authors via the journal website (http://www.e-ultrasonography.org/) as well as in the printed journals. Our journal submission page (http://submit.e-ultrasonography.org/) provides CrossCheck (http://www.crossref.org/crosscheck/index.html) information for all individual submitted papers to prevent any potential plagiarism. The CrossMark identification service (http://www.crossref.org/crossmark/) is also available at the journal website to update the status of all papers as they are published. Ultrasonography encourages video presentations to enhance understanding of the real-time properties of ultrasound procedures, and we have a YouTube address (http://www.youtube.com/user/Ultrasonography2014/) in addition to providing direct viewing of all video clips associated with published papers on the journal website. After the launching of the journal website, a total of ten thousands visit sessions from 115 different countries have been recorded (https://www.google.com/analytics/). Among the 40 articles (25 original articles, eight review articles, seven case reports) published in the four issues of Volume 33 in the first year, a review article and an original article on thyroid imaging dealing with elastography and TI-RAD were most frequently clicked on by readers (http://www.e-ultrasonography.org/index.html?v_type=4), reflecting current interests in clinical practice [2,3]. To develop into an internationally renowned journal, however, we have some problems. Most of the journal’s papers have been written by authors from the Republic of Korea. Even though our papers can be easily accessed via PubMed and Google Scholar (http://scholar.google.com/scholar?as_publication=Ultrasonography), more than 60% of the readers of our journal website are still based in Korea. Given the short time period of international exposure as an open access journal published in English, despite many visits to the journal website from all around the world, citations of our papers by international researchers have remained limited up to the present. To improve the quality of the journal’s content and draw a more diverse readership, we plan to invite international scholars to submit reviews of the latest knowledge or introductions to novel technologies. Along with the success of the annual international meeting of our society, the KSUM Open (http://2014.ksum.or.kr/), the editorial committee is encouraging conference presenters to prepare comprehensive review articles covering all the fields of medical ultrasound to enhance education for practitioners [4,5]. International researchers in the engineering of imaging technology are also invited to exchange their knowledge by publishing articles as well as presenting at our scientific meeting. We have updated the Aims & Scope and Instructions for Authors to extend the fields and types of articles in this January 2015 issue. Besides Original Articles, Review Articles, Pictorial Essays and Case Reports, two new types, Technical Notes and Perspectives have been added to keep readers up with ongoing technical developments and innovative concepts. To publish a strong range of high quality content, no authors’ submission fee or other publication-related fee has been applied for any international researchers since all costs of the publication process are underwritten by KSUM. In the mobile world, free applications are also available for all issues on the App Store and Google Play, optimizing the best in digital technology to enhance a print-like reading experience with article-sharing features and more. During the first year of Ultrasonography, the review processes were completed and the statuses of manuscripts were informed within four weeks of submission in any instance. I would like to express my special gratitude to all the reviewers for their time and expertise to make timely decisions on the manuscripts.

Contrast-enhanced ultrasound (CEUS) in nephrology: Has the time come for its widespread use?

Grey-scale ultrasound has an important diagnostic role in nephrology. The absence of ionizing radiations and nephrotoxicity, rapidity of execution, excellent repeatability, the possibility to perform the test at the patient's bed and the low cost represent important advantages of this technique. Paired with real-time sonography and colour-power-Doppler contrast-enhanced ultrasound (CEUS) reduces the diagnostic gap with computed tomography (CT) and magnetic resonance (MR) and represents a major step in the evolution of clinical ultrasound. Although there are several situations in which contrast-enhanced CT and MR are indicated (i.e. evaluation of cystic or ischemic lesions, traumatisms and ablative therapies of the native and transplanted kidney), the use of CT contrast media presents a high risk of contrast-induced nephropathy (i.e. in elderly people, subjects with comorbidities and those with renal dysfunction), while gadolinium-based RM contrast agents are contraindicated for the risk of nephrogenic systemic fibrosis (i.e. in patients with severe renal dysfunction). In these situations, CEUS may be a viable alternative, however, as any technique associated with the infusion of pharmacological substances, the potential advantages and risks of CEUS should be critically evaluated. In this regard, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has published the guidelines for the use of CEUS for the kidney imaging and the International Contrast Ultrasound Society (ICUS) has been recently founded. The aim of this review is to offer an updated overview of the potential applications of CEUS in nephrology, reporting some indications and possible risks associated to its use.

Contrast enhanced ultrasound in pediatric patients: a real challenge.

Ultrasound (US) imaging in the paediatric population has been a routine technique for decades, in part because of the advantages it offers over other imaging modalities. Off-label use (and its funding) is of the utmost importance in paediatrics because many drugs have not been evaluated in randomised trials in children. As a consequence such drugs are not specifically approved for use in children. This is also true for the contrast agents used in CEUS. The off-label use of CEUS in paediatric patients illustrates the need to deal with unresolved legal issues while at the same time balancing this with the need for high diagnostic performance in daily clinical routine. In addition to approved indications with a focus on the liver and Doppler enhancement, CEUS is safe and effective for the examination of many organs, as recently highlighted by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). This article provides a summary of the available literature describing the utility of CEUS in paediatric patients. Furthermore, we suggest the establishment of a registry to collect data on safety and applications of ultrasound contrast agents in children. A paediatric registry has recently been introduced by EFSUMB (www.efsumb.org).

Future of Breast Ultrasound in Obstetrics and Gynecology

With the advances in imaging technology, resolution and identificationof images have improved. Breast ultrasoundas a screening tool for breast cancer is a very popular topic. A few years ago, the Health Promotion Administration of the Ministry of Health and Welfare attempted to integrate related specialties countrywide, including obstetrics and gynecology, family medicine, radiology, and breast surgery, to formulate common criteria for developing an ultrasound-based breast cancer screening guideline suitable for women in Taiwan. Since 2003, the Taiwan Association of Obstetrics and Gynecology has been offering breast ultrasound examination technique training to medical specialists. Headed by Professor Fon-Jou Hsieh, the instructors’ training classes were established, and the first training was complete for the charter group of approximately 20 obstetricianegynecologists in breast ultrasound examination. With the strong support of two breast surgeons, Professors King-Jen Chang and Ming-Feng Hou, and locations chosen by the Taiwan Society of Ultrasound in Medicine for practical ultrasound field training, we were able to become familiar with performing breast ultrasound examinations within a very short time. The author was the class leader of the training class, and was responsible for the smooth implementation of the program and arrangement of subsequent ultrasound field trainings. In 2008e2009, the Taiwan Association of Obstetrics and Gynecologycompleted the two-level “basic”and“advanced”

OP0009-HPR Development and Implementation of A Musculoskeletal Ultrasound Training Program for Nurses

BackgroundMusculoskeletal ultrasound (MSUS) has become the first choice imaging investigation for the evaluation of musculoskeletal diseases. MSUS has traditionally been a task for medical doctors (MD). Over the last 10...

EchoScopy in Scanning Abdominal Diseases: Initial Clinical Experience

The introduction of a new type of small handheld ultrasound device brings greater portability and affordability. The basic ultrasound approach with these handheld devices has been defined by European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) as "EchoScopy". The current study aimed to assess the image quality, indications and limitations of a portable pocket "EchoScope" compared with a high-end ultrasound system in abdominal diseases. 231 consecutive patients were included in this study. Physician A performed ultrasound examinations with a high-end ultrasound system (HEUS), then physician B performed the same ultrasound examination using an EchoScope (Vscan™). In patients with focal lesions, physician B also measured the largest diameters and graded the vascularity by using colour Doppler imaging (CDI) within the lesion on the same plane with both ultrasound systems. Compared with the excellent image quality using HEUS, the image quality of the EchoScope was graded as good, sufficient or non-sufficient. Out of all 231 patients, 167 had focal lesions, 19 patients were found with diffuse pathological findings, six with ascites, six after liver puncture and 33 without any pathological findings. The image quality of the pocket device was considered as being good or sufficient to delineate the pathology in 225/231 (97.4 %). The detection rate of the EchoScope for abdominal focal lesion was 162/167 (97 %), only five superficially located lesions could not be detected. Both systems showed agreement in determination of the best positioning to perform abdominal paracentesis and assessing complications after intervention. The investigated EchoScope displays a sufficient image quality, in some indications such as detection of focal lesions > 20 mm, detection of ascites, hydronephrosis and other pathological findings with comparable results to HEUS. We conclude that pocket sized EchoScopy devices have a promising future but the indications have to be determined by a prospective study.

Evaluation der DEGUM-Mammasonografiekurse nach objektivierbaren Kriterien

The aim of this study was to evaluate the quality standard of the nationwide breast ultrasound training program of the German Society of Ultrasound in Medicine (DEGUM) through objective parameters. 10 quality criteria, based on the recommendations of The National Association of Statutory Health Insurance Physicians (KBV), were defined for this study. All training units of the DEGUM received a questionnaire. The questionnaires and training material were analyzed. All units met the required criteria pertaining to the trainer's qualification, duration per training course and the maximum number of participants per ultrasound machine. Only 1 course did not fulfill the required 50 % practical training time. The requirements to participate in the graduate course (200 self-made and documented cases) were not clearly conceived and a defined training log could be improved. DEGUM breast ultrasound training offers trainees a high level of education based on the requirements of the KBV. Despite the high quality of training, the content of course announcements could be improved and an official and structured educational index could be meaningful.

Contrast-Enhanced Ultrasound (CEUS) For The Evaluation Of Focal Liver Lesions – A Prospective Multicenter Study Of Its Usefulness In Clinical Practice

To assess the value of contrast-enhanced ultrasound (CEUS) for differentiating malignant from benign focal liver lesions (FLLs) and for diagnosing different FLL types. CEUS performed in 14 Romanian centers was prospectively collected between February 2011 and June 2012. The inclusion criteria were: age > 18 years; patients diagnosed with 1 - 3 de novo FLLs on B-mode ultrasound; reference method (computed tomography (CT), magnetic resonance imaging (MRI) or biopsy) available; patient's informed consent. FLL lesions were characterized during CEUS according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines. For statistical analysis, indeterminate FLLs at CEUS were rated as false classifications. A total number of 536 cases were included in the final analysis, 344 malignant lesions (64.2 %) and 192 benign lesions (35.8 %). The reference method was: CT/MRI - 379 cases (70.7 %), pathological exam - 150 cases (27.9 %) and aspiration of liver abscesses - 7 cases (1.4 %). CEUS was conclusive in 89.3 % and inconclusive in 10.7 % of cases. To differentiate between malignant and benign FLLs, CEUS had 85.7 % sensitivity, 85.9 % specificity, 91.6 % positive predictive value, 77.1 % negative predictive value and 85.8 % accuracy. The CEUS accuracy for differentiation between malignant and benign liver lesions was similar in tumors with diameter ≤ 2 cm and those with diameter > 2 cm. CEUS represents a useful method in clinical practice for differentiating between malignant and benign FLLs detected on standard ultrasonography, and the results of this study are in concordance with previous multicenter studies: DEGUM (Germany) and STIC (France).

ULTRASONOGRAPHY: a new beginning with international open access.

During the last decades, along with the great strides in diagnostic medicine and intervention, ultrasound technology has grown and global standards in research publication have been raised. After many zealous discussions and debates on the present and future academic rigor and global status of the Korean Society of Ultrasound in Medicine (KSUM), the Board of Directors of KSUM decided to convert our 32-year-old domestic journal, the Journal of Korean Society of Ultrasound in Medicine, to an international publication. For better accessibility, our renewed journal, Ultrasonography, is now being published in English and with open access, that is, with the full text of all articles freely available online. Online access to the text from past issues of the journal is also available to maintain a record of valuable research from the past. Ultrasonography is primarily dedicated to original research encompassing all of the subspecialties of ultrasound in medicine. Along with original papers, the journal also contains invited review articles about current technological or clinical issues, pictorial essays presenting intuitive educational materials, and a few select case reports having an important impact on patient management. Ultrasonography will also serve as a medium for cooperation among physicians and specialists worldwide focusing on various ultrasound technology and disease problems. We have established the Editorial Board, comprising an international group of outstanding scientists, to meet global standards in the process of peer reviewing submitted papers as well as collaborating across borders. We will try to complete the review process and inform authors of the status of their manuscripts within four to six weeks of submission. I believe that Ultrasonography will grow and will be widely noted in the near future. We envision having many distinguished papers from around the world published in our journal devoted to advances in the field of ultrasound in medicine. On behalf of all the members of the Editorial Board and publication staff, I look forward to receiving a strong range of submissions and contributions from international researchers as well as the members of the KSUM.