The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications


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 EF-SUMB 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 EF-SUMB 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.

CEUS Standards, Guidelines, Concensus Statements