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This study investigates the application and evaluation of existing indirect methods, namely point-based registration techniques, for the estimation and compensation of observed motion included in the 2-D image plane of contrast-enhanced ultrasound (CEUS)cine-loops recorded for the characterization and diagnosis of focal liver lesions (FLLs). The value of applying motion compensation in the challenging modality of CEUS is to assist in the quantification of the perfusion dynamics of an FLL in relation to its parenchyma, allowing for a potentially accurate diagnostic suggestion. Towards this end, this study also proposes a novel quantitative multi-level framework for evaluating the quantification of FLLs, which to the best of our knowledge remains undefined, notwithstanding many relevant studies. Following quantitative evaluation of 19 indirect algorithms and configurations, while also considering the requirement for computational efficiency, our results suggest that the “compact and real-time descriptor” (CARD)is the optimal indirect motion compensation method in CEUS. © 2019 World Federation for Ultrasound in Medicine & Biology

The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.

Assessment of focal liver lesions (FLLs) in contrast-enhanced ultrasound requires the delineation of the FLL in at least one frame of the acquired data, which is currently performed manually by experienced radiologists. Such a task leads to subjective results, is time-consuming and prone to misinterpretation and human error. This paper describes an attempt to improve this clinical practice by proposing a novel fast two-step method to automate the FLL segmentation, initialised only by a single seed point. Firstly, rectangular force functions are used to improve the accuracy and computational efficiency of an active ellipse model for approximating the FLL shape. Then, a novel probabilistic boundary refinement method is used to iteratively classify boundary pixels rapidly. The proposed method allows for faster and easier assessment of FLLs, whilst requiring less interaction, but producing results comparably consistent with manual delineations, and hence increasing the confidence of radiologists when making a diagnosis. Quantitative evaluation based on real clinical data, from two different European countries reflecting true clinical practice, demonstrates the value of the proposed method. © 2015 Informa UK Limited, trading as Taylor & Francis Group.

The identification and localisation of a focal liver lesion (FLL) in Contrast-Enhanced Ultrasound (CEUS) video sequences is crucial for liver cancer diagnosis, treatment planning and follow-up management. Currently, localisation and classification of FLLs between benign and malignant cases in CEUS are routinely performed manually by radiologists, in order to proceed with making a diagnosis, leading to subjective results, prone to misinterpretation and human error. This paper describes a methodology to assist clinicians who regularly perform these tasks, by discharging benign FLL cases and localise potential malignancies in a fully automatic manner by exploiting the perfusion dynamics of a CEUS video. The proposed framework uses local variations of intensity to distinguish between hyper- and hypo-enhancing regions and then analyse their spatial configuration to identify potentially malignant cases. Automatic localisation of the potential malignancy on the image plane is then addressed by clustering, using Expectation-Maximisation for Gaussian Mixture Models. A novel feature that combines description of local dynamic behaviour with spatial proximity is used in this process. Quantitative evaluation, on real clinical data from a retrospective multicentre study, demonstrates the value of the proposed method. © Springer International Publishing Switzerland 2014.

Contrast-enhanced ultrasound (CEUS) is dependent on the observer's competencies, and thus, appropriate education and testing of individual competency is essential. The current international curriculum in CEUS is methodologically weak and lacks validated competency assessment tests. In this study, we aimed to develop a syllabus for core competencies in CEUS using the Delphi process and an international panel of experts. A core writing group constructed an initial draft of the syllabus based on the existing literature. Eight international experts in CEUS or medical education were recruited as Delphi panelists. The draft underwent iterative and anonymous Delphi rounds until a pre-defined level of consensus was reached. The final syllabus consisted of 16 items, which were indexed in two main domains and in procedural order. An expert-generated proposal for a syllabus of core CEUS competencies has been constructed via the Delphi process and may serve as framework for future development of a CEUS curriculum, including competency assessment tests.

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.

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 (short version; the long version is published online).

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 (short version; the long version is published online).

This is the first part of the Guidelines on Interventional Ultrasound of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and covers all general aspects of ultrasound-guided procedures (short version; the long version is published online).

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This is the first part of the Guidelines on Interventional Ultrasound of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and covers all general aspects of ultrasound-guided procedures (long version).

The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation in clinical practice (long version).