Ultrasound in Medicine and Biology
assay showed a significant radiosensitization with AuMB+US, especially with high-dose irradiation (10 Gy). A dose modifying factor at 60% survival fraction (DMF60%) of 0.74 was obtained with AuMB and ultrasound treatment. T4-14-IN05 Multifunctional Microbubbles in Ultrasound Theranostics Chih-Kuang Yeh Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan The discipline of medical imaging is expanding beyond an assessment of anatomical structure to functional imaging and an assessment of the nature and extent of disease. This advancement is made possible by recent discoveries in molecular science, which provide the opportunity to design targeted contrast agents. Targeted imaging using ultrasound relies on contrast agents to localize a specific molecular signature or physiologic system and combines the efficacy of a contrast agent with an adhesion molecule to target the contrast directly to the desired region. Current ultrasound contrast agents are encapsulated microbubbles and have demonstrated effectiveness in cardiology and radiology. These contrast agents become identifiers of a specific molecular signature either by their preferential uptake by a physiologic system or by specific targeting of the agent through incorporation of adhesion molecules into the microbubble shell. Targeted ultrasound contrast agents provide an opportunity to image physiology or pathology that might be otherwise difficult to distinguish from the surrounding tissue without targeted contrast enhancement. This talk proposes the multi-functional microbubbles employed with ultrasound for drugs delivery/release, mechanical cell destruction, and US/MRI targeted imaging applications, thus presenting a new strategy for ultrasound theranostics. T4-14-IN11 CEUS Beyond the Liver: Vascular Application. EFSUMB Guidelines and Personal Experience Vito Cantisani, MD, PhD EFSUMB, Italy Recently EFSUMB produced the update of non-liver applications recommendations including stenosis carotid evaluation and abdominal aortic evaluation. The most recommended indication is the identification and classification of endoleak. Endo vascular aortic repair [EVAR] is performed with low perioperative morbidity and mortality rate and short hospital stay. However, EVAR needs a close and lifelong imagining surveillance for a timely detection of possible complications including endoleaks, graft migration, fractures, and enlargement of aneurysm sac size with eventual rupture. Contrast enhanced computed tomography [CTA] is actually considered the gold-standard in EVAR followup, but it is accompanied with radiation burden and renal injury due to the use of contrast media. In the last two decades several studies have shown the role of contrast enhanced ultrasound [CEUS] in post-EVAR surveillance, with very good diagnostic performance, absence of renal impairment, and no radiation, accompanied by low costs, in comparison with CTA. In numerous prospective studies and meta-analyses the detection and characterization of endoleaks with CEUS is comparable to that of CTA imaging. Nowadays, in the EVAR surveillance novel strategies which involve CEUS with a central role, are suggested by several authors and applied in many institutions. I will present a comprehensive overview and analyses of the literature on the CEUS state-of-art imagining of EVAR follow-up, with its technique, findings, diagnostic accuracy, and its role in the follow up program.
Volume 43, Number S1, 2017 T4-14-IN12 EFSUMB Non-Hepatic CEUS Guidelines – an Update Paul Sidhu King’s College London The use of contrast enhanced ultrasound is limited by a narrow licensing regulation, where there is restriction to the heart, breast, liver and peripheral vascular. Nevertheless, many practitioners employ CEUS ‘off-label’ in many areas, notably the kidneys, pancreas, aorta and bowel. All these areas currently are ‘off-label’ but this does not prevent dedicated practitioners from developing the usefulness of CEUS in clinical diagnostic procedures. The wealth of experience allows the confident use of CEUS in many areas that are currently ‘offlabel’. The recognition of this development by EFSUMB resulted in the first non-hepatic guidelines published in 2012, which detailed the many areas of CEUS practice outside conventional practice and presented the current evidence for safety and efficacy. There has been further development in the non-hepatic use of CEUS and new guidelines published in 2017. The new guidelines presents consolidation with more evidence in many areas of the usefulness of CEUS, presents the scientific data, and makes recommendations based on this evidence. These EFSUMB guidelines will allow confident evidence based management of the clinical practice of using CEUS ‘off-label’ to the benefit and safety of patients. T4-14-IN13 CEUS Guidelines: Evidence Based Medicine or off Label Use? Christian Pállson Nolsøe, Asc Prof, MD, PhD WFUMB President Elect, Diagnostic Radiologist, Ultrasound Section, Division of Surgery, Dep of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Denmark WFUMB and EFSUMB as a joint venture in 2013 published CEUS guidelines simultaneously in UMB and UiM entitled ‘‘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’’. These guidelines recommend CEUS as the first method of choice after conventional ultrasound for the diagnostic work-up of focal liver lesions. Recommendations are based on the results of multiple case series most of which are single center studies with few large multicenter design published. Also available are few systematic reviews and meta-analyses. The use of and indications for CEUS has kept growing throughout the last two decades and an increasing number of new indications for CEUS with a range of new applications has been implemented. Most of these are off-label indications. A PubMed search identified studies evaluating CEUS. Most are rather small with only eight published studies evaluating more than 200 focal liver-lesions. Available CEUS Guidelines are based on these results and an evaluation of overall performance and evidence of CEUS with special emphasis on diagnosis of malignant liver lesions will be presented. T4-14-IN14 A Phase 3 Multicentre, Randomised, Comparative Study of the Efficacy and Safety of Sonazoid and SonoVue in Subjects with Focal Liver Lesions Undergoing Pre- and Post-Contrast Ultrasound Imaging Yuxin Jiang,1 Ke Lv,1 Ping Liang,2 Huixiong Xu,3 Lianfang Du,4 Xiaoyan Xie,5 Christina Kalli,6 Geir Torheim,6 Wenping Wang7