Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) - update 2008

Ultrasound (US) contrast agents (UCAs), in conjunction with contrast specific imaging techniques, are increasingly accepted in clinical use for diagnostic imaging and post-interventional workup in several organs. To those not intimately involved in the field, the rapid advances in technology and techniques can be difficult to follow. In March of 2003, at the EUROSON Congress in Copenhagen, it was agreed that it would be useful to produce a document providing a description of essential technical requirements, proposed investigator qualifications, suggested study procedures and steps, guidance on image interpretation, recommended and established clinical indications and safety considerations. Initially a set of guidelines for the use of ultrasonic contrast agents in the liver alone were developed. These were presented and discussed in detail at an EFSUMB special consensus meeting held in Rotterdam in January 2004. The resulting consensus document was published in the August 2004 edition of Ultraschall in der Medizin/European Journal of Ultrasound, and has also been published in French [1] and Chinese [2]. Time has however moved on, and EFSUMB and the group of experts who developed these first guidelines took the view in 2006 that they should be revisited and expanded to include recommendations for applications in the kidney, in vesico-ureteric reflux, in the pancreas, in trauma and in the cerebral circulation. In order to facilitate the production of these new guidelines and recommendations a further two meetings of experts were held, the first in Bologna in September 2006 in conjunction with the EUROSON/SIUMB meeting, the second immediately following the European Symposium on Ultrasonic Contrast Agent Imaging in Rotterdam in January 2007. As previously these guidelines are based on comprehensive literature surveys including results from prospective clinical trials. On issues where no significant study data were available, evidence was obtained from expert committee reports or was based on the actual consensus of experts in the field of US and contrast enhanced Ultrasound (CEUS) during the consensus conferences. During the meeting of experts in Rotterdam many additional new and exciting developments were discussed, and whilst some are quickly entering clinical practice, it was felt too early to include them in the current recommendations. These guidelines and recommendations provide general advice for the use of UCAs. They are intended to create standard protocols for the use and administration of UCAs and improve the management of patients. Individual cases must be managed on the basis of all clinical data available for that specific case. This second version will be subject to change to reflect future advances in scientific knowledge and the rapidly evolving field of US technology.