ICUS Weekly News Monitor 11-10-2017

Aunt Minnie

Road to RSNA 2017: Ultrasound Preview

Nov 7, 2017

By Kate Madden Yee, Editor 

Dear AuntMinnie Member,

At the upcoming RSNA 2017 meeting in Chicago, you'll hear variations on the key theme of how ultrasound in its various forms helps clinicians diagnose disease, stage treatment, and track healing. Technologies under discussion will range from shear-wave elastography and contrast-enhanced ultrasound (CEUS) to MRI-guided high-intensity focused ultrasound, just to name a few.

Researchers will address a variety of clinical questions. How well does ultrasound correlate to MRI findings of suspicious lesions? How well do guidelines from the Society of Radiologists in Ultrasound define cirrhosis? Does ultrasound reduce complications in pediatric renal biopsies? And can the technology help assess the effectiveness of compression stockings to prevent delayed-onset muscle soreness? (Spoiler alert: Yes.)

Look for research that explores the use of contrast ultrasound to assess muscle injuries and hepatic artery blocks and to diagnose Crohn's disease recurrence, as well as discussion of how real-time elastography can detect "golfer's elbow"; a new technique that registers ultrasound and MRI data to help guide spine needle interventions; and whether photoacoustic ultrasound is an effective alternative to fine-needle aspiration biopsy of the thyroid.

As for breast imaging, presenters will investigate studies on everything from how screening ultrasound compares with digital breast tomosynthesis and mammography and whether real-time breast ultrasound after a second opinion can prevent unnecessary biopsies to the effect of deep-learning software on the modality's performance.

Need to up your ultrasound game? At RSNA 2017 you'll find courses that address a range of topics, including diagnosing, tracking, and treating thyroid cancer; interventional breast procedures; musculoskeletal ultrasound; vascular Doppler; and interventional sonography.

Finally, check out the RSNA's controversy session on pelvic imaging -- "When is ultrasound enough?" -- as well as sessions on emerging uses of the technology (think immuno-imaging probes and elastography) and a primer on how to integrate CEUS into radiology practice.

For highlights of some of the many ultrasound scientific sessions and posters scheduled for presentation at this year's meeting, read on. To view the RSNA's complete listing of abstracts for this year's scientific and educational program, click here.



Echo Research and Practice journal

Nov 1, 2017

The journal, Echo Research and Practice (ERP)with whom we share significant content interest, is currently being considered for indexing in Web of Science’s Science Citation Index Expanded (SCIE). Indexing in SCIE is required in order to obtain anImpact Factor, an important step in the development of any new journal.

The publication expects to receive a decision between December 2017 and March 2018. The number of citations to articles published in ERP will be critical in the decision making process. The publishers have asked for ICUS's help at this critical time by promoting the journal to our members and colleagues. The more people are aware of the journal and access its content the more citations it is likely to obtain ultimately.

If you use Twitter, the journal would very much appreciate you highlighting some of the content published in ERP to your networks. It also has a number of important conferences coming up, including the BSE Annual Meeting and EuroEcho Imaging, and will be raising the profile of the journal at both of these.



Latest Advancements in Radiology and Imaging

Oct 25, 2017

By Dr. Sudheer Pargewar ,Consultant-Diagnostic & Interventional Radiology, Global Hospitals, Mumbai

Radiology has come a long way since the discovery of X-rays in 1895 by German physicist Wilhelm Roentgen, and now plays an indispensable role in improved and better diagnosis and patient monitoring. The ever evolving stream of radiology, besides X-rays, further encompasses remarkable advances in various other modalities including ultrasonography (USG), Computed Tomography (CT scan), Magnetic Resonance Imaging (MRI) and Mammography. Furthermore, imaging guidance is now widely used for minimal invasive treatment of various medical conditions.

One of the major transitions being now adopted by many hospitals across the country is ‘going paper-less’ and the Picture Archive and Communication System (PACS) and Radiology Information System (RIS) are a giant step in this direction. Radiologists use the PACS to store the multitude of image files which can be easily retrieved at any course of time in the patient management. Thus, the entire database of images of all patients across all modalities is just a click away, saving time in locating and managing the hard copies. With the help of software solutions like RIS, it is now possible to keep a track record of every patient from scheduling appointments to diagnosis and treatment. With the digitalization of medicine, radiology data sharing is now eased out with the use of Digital Imaging and Communications in Medicine (DICOM).

The traditional X-ray films are now virtually replaced by the Computed Radiography (CR) and Digital Radiography (DR) panels with both of these having the advantage of being shared across multiple systems. Furthermore, a DR system requires less space as it obviates the need for installing the bulky CR cassette reader and also is much faster than a CR or film, with the captured image being almost instantly transferred to the workstation. In the interventional radiology (IR) suites, the versatile flat-panel computed tomography (FPCT) or flat panel volume tomography provides wide areas of coverage in each rotation provides dynamic real-time data with high spatial resolution.

Advances in breast imaging for screening and timely detection include the use of 3D Digital Breast Tomosynthesis (DBT) which reduces the overlap by normal breast tissue and has a 25-50% better mass detection rate vis-à-vis a 2D mammogram. Additionally, 3D-Automated breast ultrasound (ABUS) units are coming up to overcome the problem of screening dense breasts in young women with mammography. Mammography, USG as well as MRI guided Vacuum-assisted biopsies (VAB) may be performed for both diagnosis and treatment of small lesions.

A newer technology in USG includes the sonoelastography useful in measuring the tissue stiffness and thus finds application in staging liver fibrosis, characterization of indeterminate thyroid nodules, breast lump and lymph-nodes. Another advancement is the availability of ultrasound contrast agents, which like CT and MRI, helps in better tumor detection, particularly useful in patients with deranged renal function when CT and MRI are contraindicated. Fusion imaging (USG with CT/MRI) where images move synchronously in the same plane allow for better lesion localization while performing USG guided biopsies and ablation procedures.

CT scanners are now going further higher beyond the 64-slice with vendors offering 128-, 256-, 320- and 640- slice systems with the newer detector technology reducing scan times, radiation doses and increasing signal-to-noise ratio. Particularly useful now is non-invasive cardiac CT wherein faster scanning eliminates the need for invasive diagnostic catheter angiographies. Spectral CT (dual source or dual energy CT) helps in chemical analysis by scanning at different energies in a single scan and thus can be used to analyse kidney stones, reduce metal artefacts, diagnose gout crystals, to name a few applications.

MRI has matured further with the advent of 7T scanners and higher, improving acquisition speeds and availability of applications like functional MRI (fMRI) and diffusion tensor imaging (DTI) in neurology, cardiac MRI, time-resolved contrast-enhanced angiography, MRI enteroclysis and MR Elastography (MRE) for liver fibrosis scoring. Intraoperative MRI suites (IMRIS) allow for immediate post-operative assessment of surgical bed, without the need to mobilize the anaesthetized patient.

There is definitely more to come! And with rapid advances in each imaging modality day-by-day, the diagnosis and patient care stands to be revolutionized, faster and better.

ICUS Weekly News Monitor 10-13-2017

ICUS -- International Contrast Ultrasound Society

Lose Weight While You Sleep? Maybe Soon, According to ICUS Conference Study

Media release

October 06, 2017

CHICAGO--(BUSINESS WIRE)--Obesity can be treated with an innovative gene therapy that produces weight loss and reduces fat according to a new study described today at the 32nd annual Advances in Ultrasound conference in Chicago.

Dr. Paul Grayburn of the Baylor University Medical Center, Dallas, TX focused on a brown antipose tissue (BAT) common in hibernating animals like bears and also in children that increases energy expenditure. In Dr. Grayburn’s animal study, a protein specific to this brown antipose tissue was uncoupled to improve metabolism.

“We were able to deliver a gene ‘cocktail’ via tiny gas-filled microbubbles into skeletal muscles that lead to increased fat and glucose oxidation and weight loss,” Grayburn said.

In the study finding, the same brown antipose tissue that increases energy production in hibernating bears was activated in fatty rats and led to decreased food intake, weight loss, and reduced fat.

More than one-third (36.5%) of U.S. adults have obesity according to the Centers for Disease Control and Prevention. This promising, minimally-invasive therapy is easier and less expensive than gastric bypass surgery. The average cost of gastric bypass surgery in the US is $23,000.

In a second study at the same International Contrast Ultrasound Society (ICUS) Chicago conference, Dr. Pintong Huang used gas-filled microbubbles to deliver gene therapy in non-human primates with diabetes. His results showed the gene therapy stimulated normal glucose and insulin levels that were sustained for three to six months. Professor Huang is Chair of Ultrasonography of the Second Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, China.

Prof. Huang concluded that the results require additional larger studies which if successful show promise for human patients with diabetes.


ICUS -- International Contrast Ultrasound Society

Cheaper Way to Detect Liver Cancer Without Harmful Radiation Imaging, According to ICUS Conference Study

Media release

October 06, 2017

CHICAGO--(BUSINESS WIRE)--Doctors can effectively detect liver cancer with ultrasound and tiny microbubbles -- and without radiation, expensive MRI equipment or biopsies, according to a study announced today at the International Contrast Ultrasound Society (ICUS) 32nd Annual Conference in Chicago.

The imaging technique, known as contrast-enhanced ultrasound (CEUS), "is an exciting option because it provides a more cost effective and less invasive way for accurately characterizing the tumor," said Dr. Stephanie Wilson, a professor of radiology at the University of Calgary and study author.

The study of over 200 patients at risk for hepatocellular carcinoma, the most common liver cancer and the second leading cause of cancer deaths worldwide, found that CEUS imaging using the microbubbles allowed for the correct diagnosis with 97% accuracy.

CEUS uses liquid suspensions of tiny gas microbubbles to improve the clarity and reliability of an ultrasound image. The microbubbles are smaller than red blood cells and, when they are injected into a patient's arm vein, they flow through the microcirculation and reflect ultrasound signals, improving the accuracy of diagnostic ultrasound exams. The microbubbles are expelled from the body within minutes.

Dr. Steven Feinstein, a professor of medicine at Rush University in Chicago, said the study validates the vast benefits of using microbubble ultrasound contrast agents as a safe, convenient and effective diagnostic imaging tool. "The findings are extremely exciting and demonstrate that CEUS imaging improves patient care without exposing individuals to tissue diagnosis or ionizing radiation,” Feinstein added.

Dr. Wilson’s study utilized the Liver Imaging Reporting and Data System (LI-RADS), a tool radiologists use to classify liver tumors using CT, MR and CEUS imaging in patients with suspected liver cancer. Additional prospective studies are expected according to Dr. Yuko Kono, a professor of Hepatology and Gastroenterology at the University of California San Diego and a leader in the CEUS imaging field.

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 Sponsors

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

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