Ultraschall Med 2012; 33(4): 344-351
DOI: 10.1055/s-0032-1313026
Consensus Paper
© Georg Thieme Verlag KG Stuttgart · New York

An EFSUMB Introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for Quantification of Tumour Perfusion

Einführung des „Dynamic Contrast-Enhanced Ultrasound (DCE-US)“ zur Quantifizierung der Tumorperfusion, EFSUMB-Statement
C. F. Dietrich*
1   Innere Medizin 2, Caritas-Krankenhaus, Bad Mergentheim
,
M. A. Averkiou*
2   Department of Mechanical and Manufacturing Engineering, University of Cyprus
,
J.-M. Correas
3   Service de Radiologie adultes, Hôpital Necker, 149 rue de Sèvres, Université Paris Descartes
,
N. Lassau
4   Imaging Department, Institut Gustave Roussy
,
E. Leen
5   Imaging Department, Imperial College London
,
F. Piscaglia
6   Dept of Internal Medicine and Gastroenterology, Div. Internal Medicine, Bologna
› Author Affiliations
Further Information

Publication History

06 June 2012

25 June 2012

Publication Date:
27 July 2012 (online)

Abstract

Dynamic Contrast Enhanced Ultrasound (DCE-US) is an imaging technique that utilizes microbubble contrast agents in diagnostic ultrasound. The EFSUMB guidelines published in 2004, updated in 2008 and 2011 focused on the use of DCE-US, including essential technical requirements, training, investigational procedures and steps, guidance on image interpretation, established and recommended clinical indications and safety considerations. However the quantification of images acquired with ultrasound contrast agents (UCAs) is not discussed in the guidelines. The purpose of this EFSUMB document is to provide some recommendations and descriptions of the quantification of ultrasound images, technical requirements for analysis of time-intensity curves (TICs), methodology for data analysis, and interpretation of the results.

Zusammenfassung

Dynamic Contrast Enhanced Ultrasound (DCE-US) ist eine Quantifizierungstechnik des kontrastverstärkten Ultraschalls. Die EFSUMB-Leitlinien 2004, 2008 und 2011 erläutern die Grundlagen für Ultraschallkontrastmitteltechniken, geben aber keine detaillierte Information zu den Anwendungsmöglichkeiten, Vorgehensweise und Besonderheiten von DCE-US. Ziel dieses EFSUMB-Dokuments ist es, notwendige Grundlagen, technischen Voraussetzungen für die Analyse von Zeit-Intensitäts-Kurven und den (standardisierten) Ablauf der Daten-Analyse und Empfehlung zur Interpretation zu geben.

* Both authors contributed equally to this manuscript.


 
  • References

  • 1 Piscaglia F, Nolsoe C, Dietrich CF et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall in Med 2012; 33: 33-59
  • 2 Eisenhauer EA, Therasse P, Bogaerts J et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247
  • 3 Zhu AX, Holalkere NS, Muzikansky A et al. Early antiangiogenic activity of bevacizumab evaluated by computed tomography perfusion scan in patients with advanced hepatocellular carcinoma. Oncologist 2008; 13: 120-125
  • 4 Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30: 52-60
  • 5 Lassau N, Koscielny S, Albiges L et al. Metastatic renal cell carcinoma treated with sunitinib: early evaluation of treatment response using dynamic contrast-enhanced ultrasonography. Clin Cancer Res 2010; 16: 1216-1225
  • 6 Lassau N, Chami L, Koscielny S et al. Quantitative functional imaging by Dynamic Contrast Enhanced Ultrasonography (DCE-US) in GIST patients treated with masatinib. Invest New Drugs 2012; 30: 765-771
  • 7 Lassau N, Koscielny S, Chami L et al. Advanced hepatocellular carcinoma: early evaluation of response to bevacizumab therapy at dynamic contrast-enhanced US with quantification – preliminary results. Radiology 2011; 258: 291-300
  • 8 Williams R, Hudson JM, Lloyd BA et al. Dynamic Microbubble Contrast-enhanced US to Measure Tumor Response to Targeted Therapy: A Proposed Clinical Protocol with Results from Renal Cell Carcinoma Patients Receiving Antiangiogenic Therapy. Radiology 2011; 260: 581-590
  • 9 Averkiou M, Lampaskis M, Kyriakopoulou K et al. Quantification of tumor microvascularity with respiratory gated contrast enhanced ultrasound for monitoring therapy. Ultrasound Med Biol 2010; 36: 68-77
  • 10 Lassau N, Chami L, Chebil M et al. Dynamic contrast-enhanced ultrasonography (DCE-US) and anti-angiogenic treatments. Discov Med 2011; 11: 18-24
  • 11 Dietrich CF, Ignee A, Frey H. Contrast-enhanced endoscopic ultrasound with low mechanical index: a new technique. Z Gastroenterol 2005; 43: 1219-1223
  • 12 Dietrich CF. Contrast-enhanced low mechanical index endoscopic ultrasound (CELMI-EUS). Endoscopy 2009; 41: E43-E44
  • 13 Greis C. Technology overview: SonoVue (Bracco, Milan). Eur Radiol 2004; 14: 11-15
  • 14 Arditi M, Frinking PJ, Zhou X et al. A new formalism for the quantification of tissue perfusion by the destruction-replenishment method in contrast ultrasound imaging. IEEE Trans Ultrason Ferroelectr Freq Control 2006; 53: 1118-1129
  • 15 Hudson JM, Karshafian R, Burns PN. Quantification of flow using ultrasound and microbubbles: a disruption replenishment model based on physical principles. Ultrasound Med Biol 2009; 35: 2007-2020
  • 16 Krix M, Plathow C, Kiessling F et al. Quantification of perfusion of liver tissue and metastases using a multivessel model for replenishment kinetics of ultrasound contrast agents. Ultrasound Med Biol 2004; 30: 1355-1363
  • 17 Metoki R, Moriyasu F, Kamiyama N et al. Quantification of hepatic parenchymal blood flow by contrast ultrasonography with flash-replenishment imaging. Ultrasound Med Biol 2006; 32: 1459-1466
  • 18 Wei K, Jayaweera AR, Firoozan S et al. Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. Circulation 1998; 97: 473-483
  • 19 Reuter DA, Huang C, Edrich T et al. Cardiac output monitoring using indicator-dilution techniques: basics, limits, and perspectives. Anesth Analg 2010; 110: 799-811
  • 20 Zierler K. Indicator dilution methods for measuring blood flow, volume, and other properties of biological systems: a brief history and memoir. Ann Biomed Eng 2000; 28: 836-848
  • 21 Lampaskis M, Averkiou M. Investigation of the relationship of nonlinear backscattered ultrasound intensity with microbubble concentration at low MI. Ultrasound Med Biol 2010; 36: 306-312
  • 22 Strouthos C, Lampaskis M, Sboros V et al. Indicator dilution models for the quantification of microvascular blood flow with bolus administration of ultrasound contrast agents. IEEE Trans Ultrason Ferroelectr Freq Control 2010; 57: 1296-1310
  • 23 Krix M, Kiessling F, Vosseler S et al. Comparison of intermittent-bolus contrast imaging with conventional power Doppler sonography: quantification of tumour perfusion in small animals. Ultrasound Med Biol 2003; 29: 1093-1103
  • 24 Krix M, Kiessling F, Farhan N et al. A multivessel model describing replenishment kinetics of ultrasound contrast agent for quantification of tissue perfusion. Ultrasound Med Biol 2003; 29: 1421-1430
  • 25 Averkiou MA, Mannaris C, Bruce M et al. Nonlinear pulsing schemes for the detection of ultrasound contrast agents. Paris: Proceedings of the 155th Meeting of the ASA, Acoustics; 2008
  • 26 Cosgrove D, Lassau N. Imaging of perfusion using ultrasound. Eur J Nucl Med Mol Imaging 2010; 37: S65-S85
  • 27 Peronneau P, Lassau N, Leguerney I et al. Contrast ultrasonography: necessity of linear data processing for the quantification of tumor vascularization. Ultraschall in Med 2010; 31 (4) 370-378
  • 28 Mule S, Kachenoura N, Lucidarme O et al. An automatic respiratory gating method for the improvement of microcirculation evaluation: application to contrast-enhanced ultrasound studies of focal liver lesions. Phys Med Biol 2011; 56: 5153-5165
  • 29 Salvatore V, Borghi A, Sagrini E et al. Quantification of enhancement of focal liver lesions during contrast-enhanced ultrasound (CEUS). Analysis of ten selected frames is more simple but as reliable as the analysis of the entire loop for most parameters. Eur J Radiol 2012; 81: 709-713
  • 30 Gauthier M, Leguerney I, Thalmensi J et al. Estimation of intra-operator variability in perfusion parameter measurements using DCE-US. World J Radiol 2011; 3: 70-81