Ultrasound Image Fusion: A New Strategy to Reduce X-Ray Exposure During Image Guided Pain Therapies

Many pain procedures cannot reliably be performed with a blind technique. Thus, imaging guidance is frequently mandatory, above all when the region of interest is deep and/or difficult to reach. In recent years new imaging techniques have been developed to improve diagnosis and to display greater anatomical details. Both Radiology and Pain Therapy have developed new and more accurate techniques in interventional pain, linked to a better understanding of pathophysiology and mechanisms of pain. There are many important anesthetic blocks performed under ultrasound guidance, but our experience is manly based on pudendal nerve and sacro-iliac joint infiltration

Use of contrast-enhanced intraoperative ultrasonography during liver surgery for colorectal cancer liver metastases - Its impact on operative outcome. Analysis of a prospective cohort study

Abstract Background Preliminary reports led to discordant conclusions concerning the use of contrast-enhanced intraoperative ultrasonography (CE-IOUS) during surgery for colorectal liver metastases (CLM). The aim of this study was to evaluate the impact of CE-IOUS in patients undergoing surgery for CLM using an advanced preoperative imaging work-up, and well-established reference standards. Materials and methods Forty-seven consecutive patients underwent liver resection using IOUS and CE-IOUS for CLM. All patients underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI) within 2 weeks prior to surgery. CE-IOUS was performed by injecting intravenously 4.8 ml of sulphur-hexafluoride microbubbles (SonoVue, Bracco, Italy). Reference standards were histology, and 6-month imaging follow-up. Results IOUS discovered 43 additional lesions in 20 patients. CE-IOUS found 10 additional lesions not seen at IOUS in four patients, and confirmed all the IOUS findings. Fourteen CLM in 10 patients appeared within 6 months after surgery. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were, respectively: 66%, 0%, 98%, 0% and 65% for CT + MRI; 88%, 100%, 100%, 8%, 88% for IOUS and 93%, 100%, 100%, 13%, 93% for IOUS + CE-IOUS. In nine patients CE-IOUS afforded better definition of tumour margins thus helping in resection guidance. Conclusions CE-IOUS improves IOUS findings both for detection and for resection guidance. The combination of IOUS and CE-IOUS should be considered routinely in patients operated for CLM

Professional Standards in Medical Ultrasound - EFSUMB Position Paper (Long Version) - General Aspects

This first position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on professional standards presents a common position across the different medical professions within EFSUMB regarding optimal standards for the performing and reporting of ultrasound examinations by any professional ultrasound operator. It describes general aspects of professionality that ensure procedure quality, effectiveness, efficiency, and sustainability in virtually all application fields of medical ultrasound. Recommendations are given related to safety and indication of ultrasound examinations, requirements for examination rooms, structured examination, systematic reporting of results, and management, communication and archiving of ultrasound data. The print version of this article is a short version. The long version is published online.publishersversionPeer reviewe

Repeated radiofrequency ablation for management of patients with cirrhosis with small hepatocellular carcinomas: a long-term cohort study. Hepatology 53

In most patients with cirrhosis, successful percutaneous ablation or surgical resection of hepatocellular carcinoma (HCC) is followed by recurrence. Radiofrequency ablation (RFA) has proven effective for treating HCC nodules, but its repeatability in managing recurrences and the impact of this approach on survival has not been evaluated. To this end, we retrospectively analyzed a prospective series of 706 patients with cirrhosis (ChildPugh class B7) who underwent RFA for 859 HCC 35 mm in diameter (1-2 per patient). The results of RFA were classified as complete responses (CRs) or treatment failures. CRs were obtained in 849 nodules (98.8%) and 696 patients (98.5%). During follow-up (median, 29 months), 465 (66.8%) of the 696 patients with CRs experienced a first recurrence at an incidence rate of 41 per 100 person-years (local recurrence 6.2; nonlocal 35). Cumulative incidences of first recurrence at 3 and 5 years were 70.8% and 81.7%, respectively. RFA was repeated in 323 (69.4%) of the 465 patients with first recurrence, restoring disease-free status in 318 (98.4%) cases. Subsequently, RFA was repeated in 147 (65.9%) of the 223 patients who developed a second recurrence after CR of the first, restoring disease-free status in 145 (98.6%) cases. Overall, there were 877 episodes of recurrence (1-8 per patient); 577 (65.8%) of these underwent RFA that achieved CRs in 557 (96.5%) cases. No procedure-related deaths occurred in 1,921 RFA sessions. Estimated 3-and 5-year overall and disease-free (after repeated RFAs) survival rates were 67.0% and 40.1% and 68.0 and 38.0%, respectively. Conclusion: RFA is safe and effective for managing HCC in patients with cirrhosis, and its high repeatability makes it particularly valuable for controlling intrahepatic recurrences. (HEPATOLOGY 2010;000:000-000.) H epatocellular carcinoma (HCC) is the third leading cause of death from cancer worldwide. 1 Most HCC patients have underlying cirrhosis, which complicates management of their cancer and is often the direct cause of death. 2 Internationally endorsed guidelines currently recommend surgical resection for early-stage HCCs in patients with well-preserved liver function. 3,4 When surgery is not possible

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications : Update 2018

Funding Information: Odd Helge Gilja: Advisory Board/Consultant fee from: AbbVie, Bracco, GE Healthcare, Samsung, and Takeda Paul S. Sidhu: Speaker honoraria, Bracco, Siemens, Samsung, Hiatchi, GE and Philips Christoph F. Dietrich: Speaker honoraria, Bracco, Hitachi, GE, Mindray, Supersonic, Pentax, Olympus, Fuji, Boston Scientific, AbbVie, Falk Foundation, Novartis, Roche; Advisory, Board Member, Hitachi, Mindray, Siemens; Research grant, GE, Mindray, SuperSonic Vito Cantisani: Speaker honoraria, Canon/Toshiba, Bracco, Samsung Dominique Amy: Speaker honoraria, Hitachi, Supersonic, EpiSonica Marco Brock: Speaker honoraria, Hitachi Fabrizio Calliada: Speaker honoraria, Bracco, Hitachi, Shenshen Mindray Dirk Andre Clevert: Speaker honoraria, Siemens, Samsung, GE, Bracco, Philips; Advisory Board, Siemens, Samsung, Bracco, Philips Jean-Michel Correas: Speaker honoraria, Hitachi-Aloka, Canon/Toshiba, Philips, Supersonic, Bracco, Guerbet; Research collaboration, Bracco Sonocap, Guerbet NsSafe and Secure protocols Mirko D’Onofrio: Speaker honoraria, Siemens, Bracco, Hitachi; Advisory Board Siemens, Bracco Andre Farrokh: Speaker honoraria, Hitachi Pietro Fusaroli: Speaker honoraria, Olympus Roald Flesland Havre: Speaker honoraria, GE Healthcare, Conference participation support from Pharmacosmos, Ultrasound equipment from Samsung Medison André Ignee: Speaker honoraria: Siemens, Canon/Toshiba, Hitachi, Boston Scientific, Bracco, Supersonic, Abbvie Christian Jenssen: Speaker honoraria, Bracco, Hitachi, Canon/Toshiba, Falk Foundation, Covidien; Research grant, Novartis Maija Radzina: Speaker honoraria, Bracco, Canon/Toshiba Luca Sconfienza: Travel grants from Bracco Imaging Italia Srl, Esaote SPA, Abiogen SPA, Fidia Middle East. Speaker honoraria from Fidia Middle East Ioan Sporea: Speaker honoraria, Philips, GE, Canon/Toshiba; Advisory Board Member, Siemens; Congress participation support, Siemens Mickael Tanter: Speaker honoraria, Supersonic; Co Founder and shareholder, Supersonic; Research collaboration, Supersonic Peter Vilmann: Speaker honoraria, Pentax, Norgine; Advisory Board, Boston Scientific; Consultancy MediGlobe The following members declared no conflicts of interest: Adrian Săftoiu, Michael Bachmann Nielsen, Flaviu Bob, Jörg Bojunga, Caroline Ewertsen, Michael Hocke, Andrea Klauser, Christian Kollmann, Kumar V Ramnarine, Carolina Solomon, Daniela Fodor, Horia Ștefănescu Publisher Copyright: © 2019 Georg Thieme Verlag KG Stuttgart New York.This manuscript describes the use of ultrasound elastography, with the exception of liver applications, and represents an update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography.Peer reviewe

How to perform Contrast-Enhanced Ultrasound (CEUS)

"How to perform contrast-enhanced ultrasound (CEUS)" provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for optimal CEUS performance. CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience. The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients

Da Mezzi di contrasto in ecografia - Testo atlante

L’ecografia è, tra le metodiche di diagnostica per immagini, quella che più di ogni altra ha conosciuto una straordinaria ed ubiquitaria diffusione, coinvolgendo discipline ed operatori che vanno ben oltre l’ambito prettamente radiologico. La continua evoluzione tecnologica e l’approntamento di sofisticate apparecchiature, oggi in grado di garantire un elevatissimo contenuto informativo, hanno permesso applicazioni sempre più estese dell’ultrasonografia, tali da consentire, in alcuni settori, il conseguimento di risultati diagnostici almeno sovrapponibili a quelli derivanti dall’impiego di metodiche convenzionalmente ritenute più affidabili, quali TC e RM. L’introduzione, nella pratica clinica, degli agenti ecoamplificatori ha ulteriormente magnificato le potenzialità applicative dell’ultrasonografia, con conseguenti guadagni diagnostici sia in termini di sensibilità che di specificità: in particolare, è da segnalarne il producente utilizzo nella caratterizzazione delle lesioni focali, nella valutazione di efficacia della risposta biologica ai trattamenti terapeutici, nello studio del distretto cardiovascolare. L’uso dei mezzi di contrasto ecografici impone l’adozione di strumentazioni adeguate e l’esercizio attento di specifiche ed elevate competenze professionali: tale considerazione si correla strettamente con la necessità di garantire la più alta qualità delle prestazioni, ottimizzando l’approccio tecnico-metodologico. Ne deriva la responsabilità - che investe a pieno il ruolo delle società scientifiche e delle competenti istituzioni accademiche e sanitarie - di assicurare idonei percorsi formativi, capaci di sviluppare la diffusione delle conoscenze e di standardizzare le procedure di lavoro. In questo contesto si inserisce l’opera che qui viene presentata: nell’esprimere agli autori — noti ed affermati cultori dell’ecografia nonché pionieri, a livello nazionale ed internazionale, degli studi sull’impiego dei mezzi di contrasto - il più vivo apprezzamento, è da sottolineare con compiacimento il valore scientifico e didattico del volume, che raccoglie le esperienze cliniche dei più attivi gruppi di lavoro dell’ecografia italiana. La ricca e dimostrativa iconografia, abbinata all’essenzialità dei riferimenti testuali, conferisce alla pubblicazione un carattere eminentemente pratico, che rappresenta un utile ed insostituibile punto di riferimento per chi intenda approfondire le modalità d’impiego clinico degli agenti ecoamplificatori; in buona sostanza, uno strumento educazionale completo, aggiornato, altamente qualificato: un contributo esauriente alla definizione delle possibilità e dei limiti di questo innovativo ed affascinante ambito applicativo dell’ultrasonografia

Ultrasound imaging

Ultrasonography (US) is usually the first imaging modality chosen for the primary evaluation of the pancreas. The pancreatic gland can almost always be visualized by US. Even though there are well-known and sometimes over-emphasized limitations, the pancreatic gland can be adequately visualized by using correct US techniques, imaging and settings. Conventional US is a noninvasive and relatively low cost imaging method which is widely available and easy to perform. Tissue harmonic imaging (THI) and Doppler imaging are well known technologies that provide significant complementary information to the conventional method, playing an important role in the diagnosis and staging of pancreatic diseases. In recent decades, new interesting US methods have been developed focused on the evaluation of mechanical strain properties of tissues, such as elastography and sonoelasticity. Acoustic radiation force impulse (ARFI) imaging is a promising new US method that allows the evaluation of mechanical strain properties of deep tissues with the potential to characterize tissue without the need for external compression