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 Table of Contents  
Year : 2016  |  Volume : 5  |  Issue : 6  |  Page : 349-350

Contrast-enhanced endoscopic ultrasound: Why do we need it? A foreword

1 Department of Medical and Surgical Science, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy; Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
2 Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
3 Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany

Date of Submission02-Jul-2016
Date of Acceptance30-Jul-2016
Date of Web Publication15-Dec-2016

Correspondence Address:
Pietro Fusaroli
Department of Medical and Surgical Science, Gastroenterology Unit, Hospital of Imola, University of Bologna, Via Montericco 4, 40026, Imola, Bologna, Italy

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2303-9027.193596

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How to cite this article:
Fusaroli P, Saftoiu A, Dietrich CF. Contrast-enhanced endoscopic ultrasound: Why do we need it? A foreword. Endosc Ultrasound 2016;5:349-50

How to cite this URL:
Fusaroli P, Saftoiu A, Dietrich CF. Contrast-enhanced endoscopic ultrasound: Why do we need it? A foreword. Endosc Ultrasound [serial online] 2016 [cited 2022 Jan 22];5:349-50. Available from: http://www.eusjournal.com/text.asp?2016/5/6/349/193596

Ultrasound contrast agents (UCAs) have become quintessential for differentiating liver and other abdominal lesions, alongside transabdominal B-mode imaging.[1],[2]

In recent years, the use of UCAs has become widespread also in endoscopic ultrasound (EUS) to enhance its diagnostic accuracy in pancreaticobiliary diseases.[3],[4],[5]

Preliminary experience with the first-generation UCAs, dating back more than 15 years ago, used color and/or power Doppler imaging to perform contrast-enhanced EUS (CE-EUS). Subsequently, the second-generation UCAs were developed with dedicated contrast harmonic algorithms and quickly became established thanks to their safety and favorable learning curve.

This special issue of EUS reports on the use of UCAs to investigate pancreatic lesions, gallbladder abnormalities, submucosal tumors, lymph nodes, and other pathological conditions.

Different acronyms have been used over the years to refer to techniques incorporating UCAs. To improve comprehension of the articles in this special issue, it is worthwhile clarifying the meaning of all these terms.

Contrast-enhanced ultrasound (CEUS) was introduced as an acronym by members of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and finally accepted as the official term describing CEUS techniques in general.[1],[2],[6],[7]

Similarly, the acronym CE-EUS is used as a generic term for all contrast-enhanced techniques used with EUS, independent of particular physical principles.

Contrast enhancement techniques during EUS examinations are possible using low or high mechanical index (MI). Therefore, the acronyms for contrast-enhanced low MI-EUS (CELMI-EUS, first applied in 2003 and published in 2005 and 2009)[8],[9] and contrast-enhanced high MI-EUS (CEHMI-EUS, first published in 1997 and 2001) ensued.[10],[11],[12],[13]

Analogous to the original percutaneous approaches, CELMI-EUS describes low MI techniques, including filter/wide-band harmonic (phase or pulse) or cancellation techniques. Consequently, the terms contrast-enhanced harmonic-EUS (CEH-EUS) and contrast harmonic EUS (CH-EUS) have been used to describe low MI techniques.[14],[15],[16],[17],[18],[19],[20]

Contrast-enhanced endoscopic Doppler techniques (color Doppler, power Doppler, others) use high MI and, therefore, are included under the acronyms CEHMI-EUS or CED-EUS (contrast-enhanced Doppler-EUS). However, higher MI techniques are also used for (intermittent) harmonic imaging.

Dynamic CEUS has been adopted as the term describing time-intensity curve analysis.[5],[21] Furthermore, CEUS three-dimensional (3D) techniques were introduced as early as 2002,[22] followed by CE-EUS 3D.[23],[24] All the acronyms described to date are independent of the additional terminology used by manufacturers.

The current manufacturer's terms for low MI examination modes are as follows:

  • Wideband Pulse Inversion Contrast Harmonic Imaging (Hitachi-Pentax)
  • Contrast Harmonic-enhanced Imaging based on Extended Pure Harmonic Detection (Olympus-Aloka)
  • Contrast-harmonic Imaging-EUS (Fujinon).

Nevertheless, CEH-EUS and CH-EUS are the most widely utilized acronyms by the majority of authors. Further efforts to standardize terminology and acronyms are underway by several authorities under the auspices of the EFSUMB.

  References Top

Claudon M, Cosgrove D, Albrecht T, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) - Update 2008. Ultraschall Med 2008;29:28-44.  Back to cited text no. 1
Piscaglia F, Nolsøe 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 Med 2012;33:33-59.  Back to cited text no. 2
Fusaroli P, Saftoiu A, Mancino MG, et al. Techniques of image enhancement in EUS (with videos). Gastrointest Endosc 2011;74:645-55.  Back to cited text no. 3
Kwek BE, Ang TL, Seo DW, et al. Contrast-enhanced harmonic endoscopic ultrasonography of solid pancreatic lesions. Endosc Ultrasound 2013;2:142-7.  Back to cited text no. 4
Fusaroli P, Napoleon B, Gincul R, et al. The clinical impact of ultrasound contrast agents in EUS: A systematic review according to the levels of evidence. Gastrointest Endosc 2016. pii: S0016-510730240-1.  Back to cited text no. 5
Dietrich CF, Averkiou MA, Correas JM, et al. An EFSUMB introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for quantification of tumour perfusion. Ultraschall Med 2012;33:344-51.  Back to cited text no. 6
Claudon M, Dietrich CF, Choi BI, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver - Update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013;34:11-29.  Back to cited text no. 7
Dietrich CF, Ignee A, Frey H. Contrast-enhanced endoscopic ultrasound with low mechanical index: A new technique. Z Gastroenterol 2005;43:1219-23.  Back to cited text no. 8
Dietrich CF. Contrast-enhanced low mechanical index endoscopic ultrasound (CELMI-EUS). Endoscopy 2009;41 Suppl 2:E43-4.  Back to cited text no. 9
Bhutani MS, Hoffman BJ, van Velse A, et al. Contrast-enhanced endoscopic ultrasonography with galactose microparticles: SHU508 A (Levovist). Endoscopy 1997;29:635-9.  Back to cited text no. 10
Hirooka Y, Naitoh Y, Goto H, et al. Usefulness of contrast-enhanced endoscopic ultrasonography with intravenous injection of sonicated serum albumin. Gastrointest Endosc 1997;46:166-9.  Back to cited text no. 11
Hirooka Y, Goto H, Ito A, et al. Contrast-enhanced endoscopic ultrasonography in pancreatic diseases: A preliminary study. Am J Gastroenterol 1998;93:632-5.  Back to cited text no. 12
Becker D, Strobel D, Bernatik T, et al. Echo-enhanced color- and power-Doppler EUS for the discrimination between focal pancreatitis and pancreatic carcinoma. Gastrointest Endosc 2001;53:784-9.  Back to cited text no. 13
Kitano M, Sakamoto H, Matsui U, et al. A novel perfusion imaging technique of the pancreas: Contrast-enhanced harmonic EUS (with video). Gastrointest Endosc 2008;67:141-50.  Back to cited text no. 14
Fusaroli P, Spada A, Mancino MG, et al. Contrast harmonic echo-endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol 2010;8:629-34.e1-2.  Back to cited text no. 15
Napoleon B, Alvarez-Sanchez MV, Gincoul R, et al. Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: Results of a pilot study. Endoscopy 2010;42:564-70.  Back to cited text no. 16
Saftoiu A, Dietrich CF, Vilmann P. Contrast-enhanced harmonic endoscopic ultrasound. Endoscopy 2012;44:612-7.  Back to cited text no. 17
Kitano M, Kudo M, Yamao K, et al. Characterization of small solid tumors in the pancreas: The value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol 2012;107:303-10.  Back to cited text no. 18
Gincul R, Palazzo M, Pujol B, et al. Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: A prospective multicenter trial. Endoscopy 2014;46:373-9.  Back to cited text no. 19
Fusaroli P, Serrani M, De Giorgio R, et al. Contrast harmonic-endoscopic ultrasound is useful to identify neoplastic features of pancreatic cysts (With videos). Pancreas 2016;45:265-8.  Back to cited text no. 20
Fröhlich E, Muller R, Cui XW, et al. Dynamic contrast-enhanced ultrasound for quantification of tissue perfusion. J Ultrasound Med 2015;34:179-96.  Back to cited text no. 21
Dietrich CF. 3D real time contrast enhanced ultrasonography, a new technique. Rofo 2002;174:160-3.  Back to cited text no. 22
Hocke M, Dietrich CF. New technology - Combined use of 3D contrast enhanced endoscopic ultrasound techniques. Ultraschall Med 2011;32:317-8.  Back to cited text no. 23
Hocke M, Ignee A, Dietrich CF. Three-dimensional contrast-enhanced endoscopic ultrasound for the diagnosis of autoimmune pancreatitis. Endoscopy 2011;43 Suppl 2:E381-2.  Back to cited text no. 24

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