ICUS Weekly News Monitor 9-29-17

European Society of Cardiology

European Heart Journal - Cardiovascular Imaging(2017) 0, 1-33

Doi: 10.1093/ehjci/jex182

Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017

Authors:  Roxy Senior1*, Harald Becher2, Mark Monaghan3, Luciano Agati4, Jose Zamorano5, Jean Louis Vanoverschelde6, Petros Nihoyannopoulos7, Thor Edvardsen8, and Patrizio Lancellotti9

1Department of Cardiology, Royal Brompton Hospital, Imperial College, Sydney Street, London SW3 6NP, UK; 2Alberta Heart Institute, Edmonton, Canada; 3King’s College Hospital, London, UK; 4La Sapienza University, Rome, Italy; 5CIBERCV, University Hospital Ramon y Cajal, Madrid, Spain; 6Cliniques Universitaires St-Luc, Universite´ Catholique de Louvain, Brussels, Belgium; 7Hammersmith Hospital, Imperial College, London, UK; 8Oslo University Hospital and University of Oslo, Norway; and 9University of Liege Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liege, Belgium

September 30, 2017


Page 10: Contrast 2D echocardiography should be considered irrespective of image quality when clinical management depends on accurate measurements of LVEF such as monitoring of patients treated withcardiotoxic drugs and when implantation of ICD or CRT devices are considered (Class IIa, Level B).

It has been shown that contrast echocardiography improved confidence of the interpretation of regional LV wall motion and increased the inter-observer agreement from 80% (non-contrast tissue harmonic imaging) to 95% (2D contrast echocardiography) in intensive care unit patients.

They found an increased reproducibility of wall motion score index using contrast 2D echocardiography and that 55% of the patients were reclassified with motion abnormalities by contrast analysis. In patients 7–10 days after acute MI assessment of LV ESV and EF by contrast echocardiography showed incremental prognostic value for predicting hard events beyond clinical and non-contrast determined LV function.


European Society of Cardiology

European Heart Journal - Acute Cardiovascular Care

DOI: 10.1177/2048872617728559;

Therapeutic application of contrast ultrasound in ST elevation myocardial infarction: Role in coronary thrombosis and microvascular obstruction

Authors:  Jeroen Slikkerveer1,2, Lynda JM Juffermans1,2,3, Niels van Royen1,2, Yolande Appelman1,2, Thomas R Porter4 and Otto Kamp1,2

1 Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands; 2 Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands; 3 Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands, 4University of Nebraska Medical Center, Omaha, Nebraska, USA

Corresponding author:  Jeroen Slikkerveer, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;  Email: This email address is being protected from spambots. You need JavaScript enabled to view it. This email address is being protected from spambots. You need JavaScript enabled to view it.

September 30, 2017


In the past few decades, cardiac ultrasound has become a widely available, easy-to-use diagnostic tool in many scenarios in acute cardiac care. The introduction of microbubbles extended its diagnostic value. Not long thereafter, several investigators explored the therapeutic potential of contrast ultrasound on thrombus dissolution. Despite large improvements in therapeutic options, acute ST elevation myocardial infarction remains one of the main causes of mortality and morbidity in the western world. The therapeutic effect of contrast ultrasound on thrombus dissolution might prove to be a new, effective treatment strategy in this group of patients. With the recent publication of human studies scrutinising the therapeutic options of ultrasound and microbubbles in ST elevation myocardial infarction, we have entered a new stage in this area of research. This therapeutic effect is based on biochemical effects both at macrovascular and microvascular levels, of which the exact working mechanisms remain to be elucidated in full. This review will give an up-to-date summary of our current knowledge of the therapeutic effects of contrast ultrasound and its potential application in the field of ST elevation myocardial infarction, along with its future developments.


Health Imaging

Microbubble ultrasound, perfusion software combine to check ablation of liver lesions

By Dave Pearson

September 26, 2017

Following percutaneous interventions for malignant liver lesions, patients are ably assessed with a combination of contrast-enhanced ultrasound (CEUS) and perfusion-imaging software, according to the authors of a study published online September 25 in Ultraschall in der Medizin/European Journal of Ultrasound.

Radiologists and internists at the University of Regensburg in Germany reviewed the cases of 88 patients who had been treated with percutaneous ablation of 165 malignant liver lesions (108 hepatocellular carcinomas and 57 metastases).

Post-treatment, the patients were injected with sulfur hexafluoride microbubbles and imaged with ultrasound.

They were again assessed up to six months later, this time with contrast-enhanced CT or MRI.

Using commercially available perfusion software (Bracco’s VueBox), the researchers found “significant differences in all cases between the center compared to the margins for the main perfusion parameters,” lead author Isabel Wiesinger, MD, and colleagues report.

Further, all parameters—peak, wash-in and wash-out ratios alongside type of lesion and method of ablation—were significantly different between lesions treated successfully vs. those with recurrence, they write.

“A combination of CEUS with perfusion imaging enables critical assessment of successful treatment after percutaneous interventional procedures for a malignant liver lesion,” the authors conclude.

ICUS Weekly News Monitor 8-18-17


CEUS: Basic Training for Novices 


Stephanie Wilson, MD – ICUS Co-President and Basic Training Education Chair; University of Calgary

Andrej Lyshchik, MD, PhD – ICUS Member; Thomas Jefferson University Hospital

Event information:

September 9, 2017 Hotel Sofitel Philadelphia

8am to 4.30pm; 120 S. 17th Street Philadelphia, PA | Map

Program Description:

Expert lectures, case demonstrations and hands-on instruction for CEUS novices. Sessions will provide practical skills needed to implement a successful CEUS program – including how to determine optimal settings, inject contrast agents, and correctly interpret CEUS images.


CEUS: What, why and when?

Microbubble Contrast Agents: Safety, uses, cost effectiveness and handling.

Introduction to CEUS: Liver, kidney, other organ systems.

Getting started: From set-up to optimizing performance.

Case demonstrations: Featuring equipment of each sponsor.

Knobology: Break out rooms with personalized opportunities to "touch and feel" all of the featured ultrasound systems and contrast agents, examine settings, etc.

Who Should Attend:

Physicians, technologists, sonographers, trainees and other allied health care professionals


$125 (Includes breakfast and lunch)

To register, visit:

Accommodations: Hotel Sofitel – (215) 569-8300; ask for ICUS Event discount rate $239/night

Book by Aug 25 to get special rate!

Conference Secretariat:   This email address is being protected from spambots. You need JavaScript enabled to view it.


About ICUS:

ICUS is the only international professional society that exclusively focuses on advancing the safe and appropriate use of CEUS to improve patient care. ICUS membership is free; to join, simply ICUS Basic Training is supported by our generous sponsors.


Meeting Program

8:00 AM – 8:05 AM. Opening Remarks.

Andrej Lyshchik, MD, PhD (TJUH)

8:05 AM – 8:35 AM. Microbubble contrast agents and their Imaging Techniques.

Andrej Lyshchik, MD, PhD (TJUH)

8:35 AM – 9:15 AM. Tips of the Trade: How to do excellent CEUS examinations.

Stephanie Wilson, MD (University of Calgary)

9:15 AM – 10:00 AM. CEUS of the Liver.

Stephanie Wilson, MD (University of Calgary)

10:00 AM – 10:15 AM. Liver Imaging Reporting and Data System (LI-RADS).

Yuko Kono, MD, PhD (UCSD)

10:15 AM – 10:45 AM. Break.

10:45 AM – 11:00 AM. Clinical integration of CEUS in liver patient management.

Yuko Kono, MD, PhD (UCSD)

11:00 AM – 11:30 AM. CEUS of the Kidneys.

Andrej Lyshchik, MD, PhD (TJUH)

11:30 AM – 12:00 PM. Pediatric applications of CEUS.

Judith Machnitz, MD (CHOP)

12:00 PM – 12:15 PM. Commonly Asked Questions

Yuko Kono, MD, PhD (UCSD)

12:15 PM – 2:00 PM. Lunch / MANUFACTURERS EXIBITS.

Participants have lunch and visit manufacturers in the exhibition room. Manufacturers will demonstrate their equipment used for contrast-enhanced ultrasound. No patient scanning will be permitted.

2:00 PM – 2:30 PM. Surgical, vascular and interventional applications of CEUS.

Andrej Lyshchik, MD, PhD (TJUH)

2:30 PM – 3:00 PM. Questions & Answers.


3:00 PM – 4:15 PM. Case-Based Review: our best cases to show the scope of CEUS and to test your skills at basic interpretation.

Stephanie Wilson, MD (University of Calgary), Andrej Lyshchik, MD, PhD (TJUH)

4:15 PM – 4:30 PM. Wrap-Up


ICUS Weekly News Monitor 8-11-17

Business Journal News Network

Crouse Health unveils new ultrasound-imaging test to detect liver, kidney cancer

Aug 4, 2017

Author:  Eric Reinhardt

SYRACUSE, N.Y. — Crouse Health has introduced a new imaging test to detect liver and kidney cancers that it says “up until now has only been available in larger markets such as Boston, New York City, and Philadelphia.”

It’s called contrast-enhanced ultrasound (CEUS).

The procedure uses contrast agents called “microbubbles,” Dr. Thomas Green, chief of radiology at Crouse Health, said in a news release.

Green recently took special training in CEUS at Thomas Jefferson University in Philadelphia, Crouse Health said.

The microbubbles are “dramatically improving” the precision of diagnostic sonograms and expanding the clinical scope of a widely used, imaging modality.

Once injected in the patient’s arm, the microbubbles go directly to the suspected area of the liver or kidney, improving visualization of blood flow, the cardiovascular system and the movement of blood into vital organs, particularly the liver and kidney.

“Liver and renal lesions are very common,” Green said. “Differentiating benign from malignant can be difficult and expensive. Traditionally, this has been done with enhanced CT scanning, enhanced MRI or sometimes nuclear medicine.”

CEUS has advantages over all three methods, according to Green.

For example, CEUS doesn’t involve radiation, as CT and nuclear medicine do. It also doesn’t generate concerns about renal function or iodine contrast allergy.

It also doesn’t result in “issues” with metallic implants, internal pacemakers or claustrophobia, as an MRI (magnetic resonance imaging) procedure would produce.

And, according to Green, the test is “significantly less expensive” than other options, which is “important, especially with today’s high-deductible insurance plans.”

Crouse is expecting the number of cases using the new ultrasound-imaging test will increase once providers learn of its availability, Green adds.


Dove Medical Press

Paclitaxel-loaded and A10-3.2 aptamer-targeted poly(lactide-co-glycolic acid) nanobubbles for ultrasound imaging and therapy of prostate cancer

Jul 26, 2017

Authors:   Meng Wu,1,2 Ying Wang,3 Yiru Wang,2 Mingbo Zhang,2 Yukun Luo,2 Jie Tang,2 Zhigang Wang,4 Dong Wang,5 Lan Hao,4 Zhibiao Wang6

1School of Medicine, Nankai University, Tianjin, 2Department of Ultrasound, Chinese PLA General Hospital, Beijing, 3Wuhan Textile University, Wuhan, 4Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, 5Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, 6College of Biomedical Engineering, Chongqing Medical University, Chongqing, People’s Republic of China

Published 26 July 2017 Volume 2017:12 Pages 5313—5330



In the current study, we synthesized prostate cancer-targeting poly(lactide-co-glycolic acid) (PLGA) nanobubbles (NBs) modified using A10-3.2 aptamers targeted to prostate-specific membrane antigen (PSMA) and encapsulated paclitaxel (PTX). We also investigated their impact on ultrasound (US) imaging and therapy of prostate cancer. PTX-A10-3.2-PLGA NBs were developed using water-in-oil-in-water (water/oil/water) double emulsion and carbodiimide chemistry approaches. Fluorescence imaging together with flow cytometry verified that the PTX-A10-3.2-PLGA NBs were successfully fabricated and could specifically bond to PSMA-positive LNCaP cells. We speculated that, in vivo, the PTX-A10-3.2-PLGA NBs would travel for a long time, efficiently aim at prostate cancer cells, and sustainably release the loaded PTX due to the improved permeability together with the retention impact and US-triggered drug delivery. The results demonstrated that the combination of PTX-A10-3.2-PLGA NBs with low-frequency US achieved high drug release, a low 50% inhibition concentration, and significant cell apoptosis in vitro. For mouse prostate tumor xenografts, the use of PTX-A10-3.2-PLGA NBs along with low-frequency US achieved the highest tumor inhibition rate, prolonging the survival of tumor-bearing nude mice without obvious systemic toxicity. Moreover, LNCaP xenografts in mice were utilized to observe modifications in the parameters of PTX-A10-3.2-PLGA and PTX-PLGA NBs in the contrast mode and the allocation of fluorescence-labeled PTX-A10-3.2-PLGA and PTX-PLGA NBs in live small animals and laser confocal scanning microscopy fluorescence imaging. These results demonstrated that PTX-A10-3.2-PLGA NBs showed high gray-scale intensity and aggregation ability and showed a notable signal intensity in contrast mode as well as aggregation ability in fluorescence imaging. In conclusion, we successfully developed an A10-3.2 aptamer and loaded PTX-PLGA multifunctional theranostic agent for the purpose of obtaining US images of prostate cancer and providing low-frequency US-triggered therapy of prostate cancer that was likely to constitute a strategy for both prostate cancer imaging and chemotherapy.

ICUS Sponsors

ICUS gratefully acknowledges its 2017 sponsors:






Contact ICUS

  • Address:  International Contrast Ultrasound Society
    c/o Dentons
    233 S. Wacker Drive, Suite 5900 Chicago, IL 60606-6361
  • Telephone: 202-408-6199

About ICUS

ICUS is the world’s only professional society exclusively devoted to contrast-enhanced ultrasound (CEUS) medical imaging technology.

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