What are the guideline sources, guidelines and references for Contrast-enhanced ultrasound of the liver ?
Guideline sources The following summarized guidelines for the evaluation and management of contrast-enhanced ultrasound of the liver are prepared by our editorial team based on guidelines from the European Federation of Societies for Ultrasound (EFSU 2020). 1 Guidelines 1. Diagnostic investigations General indications: Obtain contrast-enhanced ultrasound in patients with inconclusive findings on CT or MRI. B Consider contrast-enhanced ultrasound as first-line contrast imaging modality in patients with renal insufficiency. B Indications for detecting liver malignancies: consider contrast-enhanced ultrasound for detection of liver metastasis as part of a multimodality imaging approach. C Show 2 more https://web.pathway.md/diseases/reccEtlJ9iOblblXk 1/3 6/23/23, 3:35 AM Contrast-enhanced ultrasound of the liver Pathway Indications for characterizing focal liver lesions: perform a systematic liver examination using B-mode and Doppler ultrasound before obtaining contrast-enhanced ultrasound to characterize focal liver lesions. B Show 7 more Indications for characterizing focal liver lesions in liver cirrhosis: consider contrast-enhanced ultrasound as first-line imaging technique for characterizing focal liver lesions found in patients with liver cirrhosis to establish a diagnosis of malignancy (contrast-enhanced ultrasound LR-M) or, specifically, HCC (contrast-enhanced ultrasound LR-5); however obtain CT or MRI for accurate staging unless contraindicated. C Show 3 more Indications for characterizing portal vein thrombosis: obtain contrast-enhanced ultrasound for differentiation between benign and malignant portal vein thrombosis. B 2. Diagnostic procedures Indications for guiding biopsy: Attempt contrast-enhanced ultrasound guidance to biopsy focal liver lesions that are invisible or inconspicuous on B-mode imaging. A Consider contrast-enhanced ultrasound guidance for focal liver lesions with potential necrotic areas or if previous biopsy resulted in necrotic material. C 3. Therapeutic procedures Indications for intracavitary use: Consider intracavitary contrast-enhanced ultrasound for delineation of the liver abscess cavity and identification of correct drain position and of communication with other structures. C Consider intracavitary contrast-enhanced ultrasound to guide transhepatic biliary interventions. C Indications for use in interventional tumor ablation: obtain contrast-enhanced ultrasound before US-guided ablation procedure as a complement to ultrasound, CT and MRI for treatment planning. B Show 3 more 4. Perioperative care Indications for intraoperative use: Consider contrast-enhanced intraoperative ultrasound to detect and characterize focal liver lesions not detected at preoperative imaging. B Obtain contrast-enhanced intraoperative ultrasound for assessment of the region for resection, where previously a pretreatment colorectal liver metastasis was present but has regressed. B https://web.pathway.md/diseases/reccEtlJ9iOblblXk 2/3 6/23/23, 3:35 AM Contrast-enhanced ultrasound of the liver Pathway 5. Specific circumstances Indications for use in pediatric patients: Obtain contrast-enhanced ultrasound for characterizing focal liver lesions in pediatric patients. B Obtain contrast-enhanced ultrasound follow-up of traumatic liver injuries in pediatric patients for the assessment of complications, reducing ionizing radiation exposure. B 6. Follow-up and surveillance Indications for monitoring treatment response: consider dynamic contrast-enhanced ultrasound for the quantitative assessment of response to targeted therapies in patients with malignant tumors of the liver. C 7. Quality improvement Technical considerations: ensure that the user of a contrast-enhanced ultrasound examination reports the type and dose(s) of contrast agent, the enhancement pattern and clinically relevant findings in a written format. B Show 4 more Safety considerations: IV use of ultrasound contrast agents in adult patients is safe. B Show 2 more References 1. Christoph F Dietrich, Christian P llson Nols e, Richard G Barr et al. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound CEUS in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol. 2020 Oct;46 10 2579 2604. Open https://web.pathway.md/diseases/reccEtlJ9iOblblXk 3/3