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Dietrich CF, Correas JM, Cui XW, Dong Y, Havre RF, Jenssen C, Jung EM, Krix M, Lim A, Lassau N, Piscaglia F. EFSUMB Technical Review - Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion. Ultraschall Med 2024; 45:36-46. [PMID: 37748503 DOI: 10.1055/a-2157-2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) is a technique to quantify tissue perfusion based on phase-specific enhancement after the injection of microbubble contrast agents for diagnostic ultrasound. The guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published in 2004 and updated in 2008, 2011, and 2020 focused on the use of contrast-enhanced ultrasound (CEUS), including essential technical requirements, training, investigational procedures and steps, guidance regarding image interpretation, established and recommended clinical indications, and safety considerations. However, the quantification of phase-specific enhancement patterns acquired with ultrasound contrast agents (UCAs) is not discussed here. The purpose of this EFSUMB Technical Review is to further establish a basis for the standardization of DCE-US focusing on treatment monitoring in oncology. It provides some recommendations and descriptions as to how to quantify dynamic ultrasound contrast enhancement, and technical explanations for the analysis of time-intensity curves (TICs). This update of the 2012 EFSUMB introduction to DCE-US includes clinical aspects for data collection, analysis, and interpretation that have emerged from recent studies. The current study not only aims to support future work in this research field but also to facilitate a transition to clinical routine use of DCE-US.
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Affiliation(s)
- Christoph F Dietrich
- Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Zentrum der Inneren Medizin, Johann Wolfgang Goethe Universitätsklinik Frankfurt, Frankfurt, Germany
| | - Jean-Michel Correas
- Department of Adult Radiology, Assistance Publique Hôpitaux de Paris, Necker University Hospital, Paris, France
- Paris Cité University, Paris, France
- CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Roald Flesland Havre
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Wriezen, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, Neuruppin, Brandenburg, Germany
| | - Ernst Michael Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Martin Krix
- Global Medical & Regulatory Affairs, Bracco Imaging, Konstanz, Germany
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy cancer Campus. Villejuif, France. BIOMAPS. UMR 1281. CEA. CNRS. INSERM, Université Paris-Saclay, France
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dept of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Pham KDC, Lauritzen SS, Tjora E, Gilja OH, Hatlebakk JG, Aßmus J, Havre RF. The outcome of primary per oral endoscopic myotomy (POEM) for treatment of achalasia: Norwegian single-center experience with long-term follow-up. Scand J Surg 2023; 112:3-10. [PMID: 36484306 DOI: 10.1177/14574969221139706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Per oral endoscopic myotomy (POEM) has become an established treatment for achalasia, but no Scandinavian studies with long-term follow-up exist. This study from a tertiary referral center in Norway investigates the short-, mid-, and long-term feasibility, safety, efficacy, and complications of POEM. METHODS Prospective data from the first 84 patients who underwent POEM from 2014 to 2019 were analyzed. The median follow-up time was 44 months. Clinical success was defined as the Eckardt score (ES) ⩽3, and reflux as pathological if the acid exposure time (pH < 4) was more than 6%. ES was used for symptom evaluation before, and at 6, 12, and up to 64 months after POEM. RESULTS A total of 50 males and 34 females were included. A total of 43 (51%) were treatment naïve, 24 (28.6%) had been previously treated with botulinum toxin, pneumatic balloon dilatation, or both, and 17 (20.2%) were previously treated with Heller's myotomy. The median post-POEM ES at 12 months was 1 (0-9), compared to pre-POEM 7 (4-12) (p < 0.01). At 12 months after POEM, clinical success persisted in 74 patients (88.1%). Clinical success was the highest for patients who were naïve to treatment, 41/43 (95%), and lower for those previously treated with Heller's myotomy 12/17 (70.6%). Long-term follow-up at 5-6 years of 42 patients showed a clinical success rate of 94%. We experienced adverse events in five patients (6%). Post-POEM pathological reflux was found in 46% (28/61). After 3-4 years, the median ES was 1, and after 5-6 years, it was 2. CONCLUSION POEM was safe and relieved the symptoms of achalasia significantly and persistently. The procedure had a better outcome in treatment naïve than previously treated patients. However, POEM is associated with significantly increased esophageal acid exposure. TWITTER SUMMARY Norwegian single-center study: POEM had a clinical success rate of 94% after 5-6 years since its introduction at the center in 2014, providing a safe and effective treatment for achalasia.
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Affiliation(s)
- Khanh Do-Cong Pham
- Department of Medicine Haukeland University Hospital Jonas Lies vei 65 5021 Bergen.,Norway Department of Clinical Medicine University of Bergen Bergen Norway.,Bergen Research Group for Advanced Gastrointestinal Endoscopy (BRAGE) Haukeland University Hospital Bergen Norway
| | - Sigurd Strumse Lauritzen
- Bergen Research Group for Advanced Gastrointestinal Endoscopy (BRAGE), Haukeland University Hospital, Bergen, Norway
| | - Erling Tjora
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Odd Helge Gilja
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Jan Gunnar Hatlebakk
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Roald Flesland Havre
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Bergen Research Group for Advanced Gastrointestinal Endoscopy (BRAGE), Haukeland University Hospital, Bergen, Norway
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Wüstner M, Radzina M, Calliada F, Cantisani V, Havre RF, Jenderka KV, Kabaalioğlu A, Kocian M, Kollmann C, Künzel J, Lim A, Maconi G, Mitkov V, Popescu A, Saftoiu A, Sidhu PS, Jenssen C. Professional Standards in Medical Ultrasound - EFSUMB Position Paper (Short Version) - General Aspects. Ultraschall Med 2022; 43:456-463. [PMID: 35850146 DOI: 10.1055/a-1854-2936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Matthias Wüstner
- Central Interdisciplinary Sonography, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Maija Radzina
- Radiology Research laboratory, Riga Stradins University, Riga, Latvia
- Diagnostic Radiology Institute, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, ROME, Italy
| | - Roald Flesland Havre
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Milan Kocian
- Anästhesie und Intensiv, Asklepios Klinik Burglengenfeld, Germany
- Visual Medicine s. r. o., Olomouc, Czech Republic
| | - Christian Kollmann
- Center for Medical Physics & Biomedical Engineering, Medical University Vienna, Austria
| | - Julian Künzel
- Otorhinolaryngology, University of Regensburg, Germany
| | - Adrian Lim
- Imaging, Imperial College, London, United Kingdom of Great Britain and Northern Ireland
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, "L. Sacco" University Hospital, Milan, Italy
| | - Vladimir Mitkov
- Diagnostic Ultrasound Division, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Alina Popescu
- Gastroenterology, University of Medicine and Pharmacy Timisoara, Romania
| | - Adrian Saftoiu
- Res Ctr Gastroenterol Hepatol, University of Medicine and Pharmacy of Craiova, Romania
| | - Paul S Sidhu
- Radiology, King's College London, United Kingdom of Great Britain and Northern Ireland
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
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Mjelle AB, Mulabecirovic A, Havre RF, Olafsdottir EJ, Gilja OH, Vesterhus M. Liver Elastography in Healthy Children Using Three Different Systems - How Many Measurements Are Necessary? Ultraschall Med 2022; 43:488-497. [PMID: 33348414 DOI: 10.1055/a-1283-5906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Liver elastography is increasingly being applied in screening for and follow-up of pediatric liver disease, and has been shown to correlate well with fibrosis staging through liver biopsy. Because time is of the essence when examining children, we wanted to evaluate if a reliable result can be achieved with fewer acquisitions. MATERIALS AND METHODS 243 healthy children aged 4-17 years were examined after three hours of fasting. Participants were divided into four age groups: 4-7 years; 8-11 years; 12-14 years and 15-17 years. Both two-dimensional shear wave elastography (2D-SWE; GE Logiq E9) and point shear wave elastography (pSWE; Samsung RS80A with Prestige) were performed in all participants, while transient elastography (TE, Fibroscan) was performed in a subset of 87 children aged 8-17 years. Median liver stiffness measurement (LSM) values of 3, 4, 5, 6, 7, and 8 acquisitions were compared with the median value of 10 acquisitions (reference standard). Comparison was performed for all participants together as well as within every specific age group. We investigated both the intraclass correlation coefficient (ICC) with absolute agreement and all outliers more than 10 %, 20 % or ≥ 0.5 or 1.0 kPa from the median of 10 acquisitions. RESULTS For all three systems there was no significant difference between three and ten acquisitions, with ICCs ≥ 0.97. All systems needed 4 acquisitions to achieve no LSM deviating ≥ 1.0 kPa of a median of ten. To achieve no LSM deviating ≥ 20 % of a median of ten acquisitions, pSWE and TE needed 4 acquisitions, while 2D-SWE required 6 acquisitions. CONCLUSION Our results contradict recommendations of 10 acquisitions for pSWE and TE and only 3 for 2D-SWE.
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Affiliation(s)
- Anders Batman Mjelle
- Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anesa Mulabecirovic
- Department of Clinical Medicine, Universitetet i Bergen Det medisinsk-odontologiske fakultet, Bergen, Norway
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Edda Jonina Olafsdottir
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
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Wüstner M, Radzina M, Calliada F, Cantisani V, Havre RF, Jenderka KV, Kabaalioğlu A, Kocian M, Kollmann C, Künzel J, Lim A, Maconi G, Mitkov V, Popescu A, Saftoiu A, Sidhu PS, Jenssen C. Professional Standards in Medical Ultrasound - EFSUMB Position Paper (Long Version) - General Aspects. Ultraschall Med 2022; 43:e36-e48. [PMID: 35850145 DOI: 10.1055/a-1857-4435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Matthias Wüstner
- Central Interdisciplinary Sonography, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Maija Radzina
- Radiology Research laboratory, Riga Stradins University, Riga, Latvia
- Diagnostic Radiology Institute, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, ROME, Italy
| | - Roald Flesland Havre
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Milan Kocian
- Anästhesie und Intensiv, Asklepios Klinik, Burglengenfeld, Germany
- Visual Medicine s. r. o., Olomouc, Czech Republic
| | - Christian Kollmann
- Center for Medical Physics & Biomedical Engineering, Medical University Vienna, Austria
| | - Julian Künzel
- Otorhinolaryngology, University of Regensburg, Germany
| | - Adrian Lim
- Imaging, Imperial College, London, United Kingdom of Great Britain and Northern Ireland
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L. Sacco" University Hospital, "L. Sacco" University Hospital, Milan, Italy
| | - Vladimir Mitkov
- Diagnostic Ultrasound Division, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Alina Popescu
- Gastroenterology, University of Medicine and Pharmacy, Timisoara, Romania
| | - Adrian Saftoiu
- Res Ctr Gastroenterol Hepatol, University of Medicine and Pharmacy of Craiova, Romania
| | - Paul S Sidhu
- Radiology, King's College London, United Kingdom of Great Britain and Northern Ireland
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
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Nordaas IK, Engjom T, Gilja OH, Havre RF, Sangnes DA, Haldorsen IS, Dimcevski G. Diagnostic Accuracy of Transabdominal Ultrasound and Computed Tomography in Chronic Pancreatitis: A Head-to-Head Comparison. Ultrasound Int Open 2021; 7:E35-E44. [PMID: 34447899 PMCID: PMC8384479 DOI: 10.1055/a-1542-9146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/19/2021] [Indexed: 10/27/2022] Open
Abstract
Purpose Computed tomography (CT) is the most used imaging modality for diagnosing chronic pancreatitis (CP), but advances in transabdominal ultrasound (US) technology have given US a position as a viable alternative. We aimed to evaluate the diagnostic accuracy of abdominal CT and pancreatic US compared to the reference standard, a modified Mayo score. Materials and Methods CT, US, and endoscopic ultrasound (EUS) were performed in patients referred due to suspected CP. The modified Mayo score included EUS results, clinical presentation, and results from exocrine and endocrine pancreatic function tests. We scored CT findings according to the modified Cambridge classification and US findings according to the Rosemont classification. Results In total, 73 patients were included. 53 patients (73%) were categorized as CP and 20 (27%) as non-CP. CT and US yielded similar sensitivities (68% and 64%, respectively) and specificities (75 and 85%, respectively) and similar areas under the receiver operating characteristic curves for diagnosing CP. We found no significant differences between the areas under the receiver operating characteristic curves (AUROCs) for CT (AUROC 0.75, 95% CI 0.63-0.87) and US (AUROC 0.81, 95% CI 0.71-0.91). Conclusion We conclude that CT and US had comparable, moderate accuracy in diagnosing CP. Neither modality had high enough sensitivity to exclude the diagnosis as a standalone method.
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Affiliation(s)
- Ingrid Kvåle Nordaas
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Trond Engjom
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Dag André Sangnes
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingfrid S Haldorsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Mohn Medical Imaging and Visualization Centre, Department of Radiology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway
| | - Georg Dimcevski
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Havre RF, Dai C, Roug S, Novovic S, Schmidt PN, Feldager E, Karstensen JG, Pham KDC. EUS-guided gastroenterostomy with a lumen apposing self-expandable metallic stent relieves gastric outlet obstruction - a Scandinavian case series. Scand J Gastroenterol 2021; 56:972-977. [PMID: 34236273 DOI: 10.1080/00365521.2021.1925338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND EUS-guided gastroenterostomy (EUS-GE) with lumen-apposing metallic stents (LAMS) in patients with gastric outlet obstruction (GOO) has proven to be an alternative to luminal stenting in the duodenum and surgical gastroenterostomy. In severely ill patients, the method can provide improved quality of life (QoL) and symptom relief by restoration of the luminal passage of fluid and nutrients to the small intestine. AIM To assess the technical and clinical success and safety of EUS-GE. MATERIAL AND METHODS A dual center retrospective case series of 33 consecutive patients with GOO due to malignant (n = 28) or non-malignant conditions (n = 5). The patients were treated with EUS-GE using cautery enhanced LAMS. Procedures were performed guided by EUS and fluoroscopy in general anesthesia or conscious sedation. RESULTS Technical success was achieved in all patients. The median procedure time was 71 min and the median hospital stay was three days. Thirty (91%) patients were able to resume oral nutrition after the procedure. Ten patients (30%) experienced adverse events (AEs), including migration of the stent, bleeding, and infection. Four patients had fatal AEs (12%). All stent-related AEs were handled endoscopically. Five patients (15%) needed re-intervention. The median survival time for patients with malignant obstruction was 8.5 weeks (0.5-76), and 13 patients with obstructing malignancies lived 12 weeks or longer. CONCLUSION EUS-GE is a minimally invasive and efficient method for restoration of the gastrointestinal passage and may improve palliative care for patients with GOO. The method has potential hazards and should only be offered in expert centers that regularly perform the procedure.
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Affiliation(s)
- R F Havre
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - C Dai
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - S Roug
- Gastro Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - S Novovic
- Gastro Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - P N Schmidt
- Gastro Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - E Feldager
- Gastro Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - J G Karstensen
- Gastro Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - K D C Pham
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Mjelle AB, Mulabecirovic A, Olafsdottir EJ, Gilja OH, Havre RF, Vesterhus M. Controlled Attenuation Parameter in Healthy Individuals Aged 8-70 Years. Ultrasound Int Open 2021; 7:E6-E13. [PMID: 33969259 PMCID: PMC8096534 DOI: 10.1055/a-1461-4714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/21/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Anders Batman Mjelle
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Edda Jonina Olafsdottir
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Odd Helge Gilja
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway.,National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Roald Flesland Havre
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway.,National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Mette Vesterhus
- Department of Medicine, Haraldsplass Diakonale Sykehus AS, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Abstract
OBJECTIVES Computed tomography (CT) is the most commonly used imaging modality when diagnosing chronic pancreatitis (CP). We aimed to evaluate the diagnostic accuracy of CT scores for diagnosing CP. METHODS One hundred eighteen patients were retrospectively included from an observational cohort study that comprised patients referred because of suspected CP. Patients were categorized as CP or non-CP using a modified Mayo score based on biochemistry, clinical presentation, and findings on endoscopic ultrasound and/or transabdominal ultrasound. The CT scans were scored according to the modified Cambridge classification and the unweighted CT score. Diagnostic performance indices were calculated using the modified Mayo score as reference standard. RESULTS Seventy-six of the 118 patients fulfilled the CP diagnostic criteria (Mayo score ≥4). The modified Cambridge classification and the unweighted CT score yielded sensitivities of 63% and 67% and specificities of 91% and 91%, respectively, and similar areas under the receiver operating characteristic curves (95% confidence interval) of 0.79 (0.71-0.88)/0.81 (0.73-0.89), respectively (P, not significant). CONCLUSIONS Both CT scores had similar, moderate accuracies for diagnosing CP. The limitation in diagnostic accuracy makes CT ineligible as a single method to diagnose CP, supporting that the diagnostic process for CP needs to incorporate other imaging methods and/or markers for better diagnostics.
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Affiliation(s)
- Khanh Do-Cong Pham
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway
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Trimboli P, Castellana M, Virili C, Havre RF, Bini F, Marinozzi F, D’Ambrosio F, Giorgino F, Giovanella L, Prosch H, Grani G, Radzina M, Cantisani V. Performance of contrast-enhanced ultrasound (CEUS) in assessing thyroid nodules: a systematic review and meta-analysis using histological standard of reference. Radiol Med 2020; 125:406-415. [DOI: 10.1007/s11547-019-01129-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/27/2019] [Indexed: 12/21/2022]
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Engjom T, Pham KDC, Erchinger F, Haldorsen IS, Gilja OH, Dimcevski G, Havre RF. Good Agreement Between Transabdominal and Endoscopic Ultrasound of the Pancreas in Chronic Pancreatitis. Ultraschall Med 2019; 40:609-617. [PMID: 29579746 DOI: 10.1055/a-0583-8254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE We aimed to evaluate the agreement of single criteria and dedicated scores from transabdominal ultrasound of the pancreas (US) compared to standards by endoscopic ultrasound (EUS) and computed tomography (CT). MATERIALS AND METHODS In this observational cohort study performed in a tertiary care center, US and EUS were performed in 110 patients referred for suspected CP. Based on the Mayo score, 52 patients were diagnosed with CP. The sonographic findings obtained by both methods were registered. The number of criteria was counted and scored according to the Rosemont score. RESULTS Agreement between the number of detected US and EUS criteria was substantial (ICC = 0.74 [0.61-0.83]. Adding Rosemont weighting improved the agreement (ICC = 0.88 [0.81-0.92]). Regarding individual criteria, the agreement was substantial for the detection of calcifications (κ = 0.86) and moderate for cysts and irregular or dilated pancreatic duct (κ = 0.42-0.58). Agreement for the other criteria was poorer (κ≤ 0.40). The diagnostic performance indices [95 % CI] of US for diagnosing CP (using Mayo score as reference standard) were for the unweighted score: Sensitivity: 0.65 [0.51-0.78], specificity: 0.97 [0.87-1.00]; and for Rosemont score: Sensitivity: 0.75 [0.61-0.86], specificity: 0.95 [0.83-0.99]. CONCLUSION The agreement between US and EUS for the unweighted and weighted scores was substantial. For the features calcifications, cysts and main pancreatic duct (MPD) changes, agreement was moderate to substantial. For the other detected US criteria, the agreement with EUS was too poor to be clinically relevant.
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Affiliation(s)
- Trond Engjom
- Department of Medicine, Haukeland Universitetssjukehus, Bergen, Norway
| | | | - Friedemann Erchinger
- Department of Clinical Medicine, Universitetet i Bergen Det Matematisk-naturvitenskapelige Fakultet, Bergen, Norway
| | | | - Odd Helge Gilja
- Department of Clinical Medicine, Universitetet i Bergen Det medisinsk-odontologiske fakultet, Bergen, Norway
| | - Georg Dimcevski
- Department of Medicine, Haukeland Universitetssjukehus, Bergen, Norway
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
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13
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Săftoiu A, Gilja OH, Sidhu PS, Dietrich CF, Cantisani V, Amy D, Bachmann-Nielsen M, Bob F, Bojunga J, Brock M, Calliada F, Clevert DA, Correas JM, D'Onofrio M, Ewertsen C, Farrokh A, Fodor D, Fusaroli P, Havre RF, Hocke M, Ignee A, Jenssen C, Klauser AS, Kollmann C, Radzina M, Ramnarine KV, Sconfienza LM, Solomon C, Sporea I, Ștefănescu H, Tanter M, Vilmann P. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018. Ultraschall Med 2019; 40:425-453. [PMID: 31238377 DOI: 10.1055/a-0838-9937] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Paul S Sidhu
- Department of Radiology, King's College London, King's College Hospital, United Kingdom of Great Britain and Northern Ireland
| | | | - Vito Cantisani
- Radiological, Pathological and Oncological Sciences Department, University Sapienza, Rome, Italy
| | - Dominique Amy
- Radiology Department, Breast Center, Aix-en-Provence, France
| | | | - Flaviu Bob
- Nephrology Department, University of Medicine and Pharmacy "Victor Babeș" Timișoara, Romania
| | - Jörg Bojunga
- Med. Klinik I, Department of Endocrinology Universitätsklinikum, Frankfurt am Main, Germany
| | - Marko Brock
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Germany
| | - Fabrizio Calliada
- Department of Radiology, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Dirk André Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Jean-Michel Correas
- Service de Radiologie adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Caroline Ewertsen
- Department of Radiology, Copenhagen-University-Hospital, Rigshospitalet, Copenhagen OE, Denmark
| | - André Farrokh
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Germany
| | - Daniela Fodor
- 2nd Medical Clinic, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Pietro Fusaroli
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | | | - André Ignee
- Medizinische Klinik 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
| | | | - Christian Kollmann
- Center for Medical Physics & Biomedical Engineering, Medical University of Vienna, Austria
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, Medical faculty, University of Latvia, Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Kumar V Ramnarine
- Medical Physics Department, Guy's and St Thomas' NHS Foundation Trust, London, and University of Leicester, Leicester, United Kingdom of Great Britain and Northern Ireland
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy and Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Carolina Solomon
- Radiology Department, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeș" Timișoara, Romania
| | - Horia Ștefănescu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mickael Tanter
- Physics for Medicine Paris Institute, INSERM, CNRS, ESPCI Paris, France
| | - Peter Vilmann
- Endoscopy Department, Copenhagen University Hospital Herlev, Denmark
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Affiliation(s)
- Khanh Do-Cong Pham
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, K1, University of Bergen, Norway
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15
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Pham KD, Havre RF, Langø T, Hofstad EF, Tangen GA, Mårvik R, Pham T, Gilja OH, Hatlebakk JG, Viste A. Navigated retrograde endoscopic myotomy (REM) for the treatment of therapy-resistant achalasia. Neurogastroenterol Motil 2018; 30:e13252. [PMID: 29144018 DOI: 10.1111/nmo.13252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND In achalasia, muscle spasm may involve the proximal esophagus. When the muscle spasm is located in the proximal esophagus, conventional per oral endoscopic myotomy (POEM) may not be sufficient to relieve symptoms. In this paper, we describe retrograde endoscopic myotomy (REM) as a novel approach to perform myotomy of the proximal esophagus, with the application of a navigation tool for anatomical guidance during REM. We aim to evaluate the feasibility and safety of REM and usefulness of the navigation during REM. METHOD A 42-year-old male with type III achalasia who was treated with laparoscopic myotomy with fundoplication, multiple pneumatic balloon dilations, Botox injections and anterior POEM of the middle and distal esophagus without symptomatic effect. Repeated high-resolution- manometry (HRM) revealed occluding contractions of high amplitude around and above the aortic arch. A probe-based real-time electromagnetic navigation platform was used to facilitate real-time anatomical orientation and to evaluate myotomy position and length during REM. RESULTS The navigation system aided in identifying the major structures of the mediastinum, and position and length of the myotomy. Twelve weeks after REM, the Eckardt score fell from seven at baseline seven to two. We also observed improvement with reduction of the pressure at the level of previous spasms in the proximal esophagus from 124 mmHg to 8 mmHg on HRM. CONCLUSION REM makes the proximal esophagus accessible for endoscopic myotomy. Potential indication for REM is motility disorders in the proximal esophagus and therapy failure after POEM.
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Affiliation(s)
- K D Pham
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R F Havre
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - T Langø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway
| | - E F Hofstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | - G A Tangen
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | - R Mårvik
- Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, St. Olav Hospital, Trondheim, Norway
| | - T Pham
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - O H Gilja
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - J G Hatlebakk
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Viste
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway
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16
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Bende F, Mulabecirovic A, Sporea I, Popescu A, Sirli R, Gilja OH, Vesterhus M, Havre RF. Assessing Liver Stiffness by 2-D Shear Wave Elastography in a Healthy Cohort. Ultrasound Med Biol 2018; 44:332-341. [PMID: 29249457 DOI: 10.1016/j.ultrasmedbio.2017.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/16/2017] [Accepted: 10/26/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to assess the normal ranges of liver stiffness measurements (LSMs) in participants with healthy livers, using General Electric 2-D shear wave elastography (2-D-SWE-GE) compared with transient elastography (TE). We included 80 participants with healthy livers and without known liver disease, in whom liver stiffness was evaluated in the same session using two elastographic methods, TE and 2-D-SWE-GE. Reliable LSMs were defined for TE as the median of 10 measurements with a success rate of ≥60% and an interquartile range (IQR) < 30%, and for 2-D-SWE-GE, as the median of 10 measurements acquired in a homogenous area and an IQR < 30%. Participants with LSMs > 6.5 kPa by TE were excluded. Reliable LSMs were obtained in 79 participants (98.7%) by means of 2-D-SWE-GE and in 80 participants (100%) by means of TE (p = 0.9). The mean LSM obtained by 2-D-SWE-GE in our cohort of participants with healthy livers was 5.1 ± 1.3 kPa, which was significantly higher than the LSM assessed by TE (4.3 ± 0.9 kPa, p < 0.0001). In 2-D SWE-GE, mean LSMs were significantly higher for men than for women, 5.9 ± 1.2 kPa versus 4.7 ± 1.2 kPa (p = 0.0005). In conclusion, 2-D-SWE-GE has very good feasibility (98.7%) in healthy persons. The mean LSM determined by 2-D-SWE-GE in healthy participants was 5.1 ± 1.3 kPa. LSMs obtained by means of 2-D-SWE-GE were higher than those obtained by TE in participants with healthy livers.
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Affiliation(s)
- Felix Bende
- Department of Gastroenterology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Anesa Mulabecirovic
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Ioan Sporea
- Department of Gastroenterology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Alina Popescu
- Department of Gastroenterology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania.
| | - Roxana Sirli
- Department of Gastroenterology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Odd Helge Gilja
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Mette Vesterhus
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway; Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Roald Flesland Havre
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
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17
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Mulabecirovic A, Mjelle AB, Gilja OH, Vesterhus M, Havre RF. Repeatability of shear wave elastography in liver fibrosis phantoms-Evaluation of five different systems. PLoS One 2018; 13:e0189671. [PMID: 29293527 PMCID: PMC5749729 DOI: 10.1371/journal.pone.0189671] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/29/2017] [Indexed: 12/15/2022] Open
Abstract
This study aimed to assess and validate the repeatability and agreement of quantitative elastography of novel shear wave methods on four individual tissue-mimicking liver fibrosis phantoms with different known Young’s modulus. We used GE Logiq E9 2D-SWE, Philips iU22 ARFI (pSWE), Samsung TS80A SWE (pSWE), Hitachi Ascendus (SWM) and Transient Elastography (TE). Two individual investigators performed all measurements non-continued and in parallel. The methods were evaluated for inter- and intraobserver variability by intraclass correlation, coefficient of variation and limits of agreement using the median elastography value. All systems used in this study provided high repeatability in quantitative measurements in a liver fibrosis phantom and excellent inter- and intraclass correlations. All four elastography platforms showed excellent intra-and interobserver agreement (interclass correlation 0.981–1.000 and intraclass correlation 0.987–1.000) and no significant difference in mean elasticity measurements for all systems, except for TE on phantom 4. All four liver fibrosis phantoms could be differentiated by quantitative elastography, by all platforms (p<0.001). In the Bland-Altman analysis the differences in measurements were larger for the phantoms with higher Young’s modulus. All platforms had a coefficient of variation in the range 0.00–0.21 for all four phantoms, equivalent to low variance and high repeatability.
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Affiliation(s)
- Anesa Mulabecirovic
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Anders Batman Mjelle
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Odd Helge Gilja
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Mette Vesterhus
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Cancer Medicine, Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
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18
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Kovacevic B, Karstensen JG, Havre RF, Pham KDC, Giovannini M, Dabizzi E, Arcidiacono P, Santo E, Sequeiros EV, Klausen P, Rift CV, Hasselby JP, Toxværd A, Kalaitzakis E, Hansen CP, Vilmann P. Initial experience with EUS-guided microbiopsy forceps in diagnosing pancreatic cystic lesions: A multicenter feasibility study (with video). Endosc Ultrasound 2018; 7:383-388. [PMID: 30168479 PMCID: PMC6289018 DOI: 10.4103/eus.eus_16_18] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Cystic lesions of the pancreas represent a diagnostic dilemma. Recently, a through-the-needle microbiopsy forceps has become available, enabling procurement of EUS-guided histological specimens from the pancreatic cyst wall. The aim of this study was to evaluate the use of this novel instrument in a multicenter clinical setting. Patients and Methods Patients referred for EUS evaluation of pancreatic cysts and attempted EUS-guided microbiopsy was included retrospectively from six international tertiary centers. Patient's demographics, EUS findings, technical and clinical success, and histopathological results were recorded. Results : A total of 28 patients were identified. We report a technical success rate of 85.7% (n = 24). Biopsies were generally of good quality and contributed to the diagnosis in 20 patients (clinical success of 71.4%). Three adverse events were recorded (10.7%). Conclusions The use of the microbiopsy forceps is feasible with acceptable rates of technical and clinical success. Prospective studies are warranted to determine the diagnostic potential compared to the other modalities. However, the results from this preliminary study are promising.
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Affiliation(s)
- Bojan Kovacevic
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - John Gásdal Karstensen
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev; Department of Gastrointestinal Surgery, Slagelse Hospital, Slagelse, Denmark
| | | | | | - Marc Giovannini
- Department of Hepato-Gastroenterology, Institut Paoli Calmettes, Marseille, France
| | - Emanuele Dabizzi
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Milan, Italy
| | - Erwin Santo
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Pia Klausen
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Charlotte Vestrup Rift
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jane Preuss Hasselby
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anders Toxværd
- Department of Pathology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Evangelos Kalaitzakis
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- Department of Gastrointestinal Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Vilmann
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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Dietrich CF, Barr RG, Farrokh A, Dighe M, Hocke M, Jenssen C, Dong Y, Saftoiu A, Havre RF. Strain Elastography - How To Do It? Ultrasound Int Open 2017; 3:E137-E149. [PMID: 29226273 DOI: 10.1055/s-0043-119412] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022] Open
Abstract
Tissue stiffness assessed by palpation for diagnosing pathology has been used for thousands of years. Ultrasound elastography has been developed more recently to display similar information on tissue stiffness as an image. There are two main types of ultrasound elastography, strain and shear wave. Strain elastography is a qualitative technique and provides information on the relative stiffness between one tissue and another. Shear wave elastography is a quantitative method and provides an estimated value of the tissue stiffness that can be expressed in either the shear wave speed through the tissues in meters/second, or converted to the Young's modulus making some assumptions and expressed in kPa. Each technique has its advantages and disadvantages and they are often complimentary to each other in clinical practice. This article reviews the principles, technique, and interpretation of strain elastography in various organs. It describes how to optimize technique, while pitfalls and artifacts are also discussed.
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Affiliation(s)
| | - Richard G Barr
- Radiology, Northeastern Ohio Medical University, Rootstown, United States
| | - André Farrokh
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Manjiri Dighe
- Department of Biology, University of Washington, Radiology, Seattle, United States
| | - Michael Hocke
- HELIOS Klinikum Meiningen, Internal Medicine II, Meiningen, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
| | - Adrian Saftoiu
- University of Medicine and Pharmacy of Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
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20
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Kalaitzakis E, Havre RF, Willemoe GL, Meisner S. Colonic perforation following endoscopic mucosal resection in a patient on bevacizumab treatment. Endoscopy 2017; 48 Suppl 1:E224-5. [PMID: 27341201 DOI: 10.1055/s-0042-109604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Evangelos Kalaitzakis
- Endoscopy Unit, Copenhagen University Hospital/Herlev, University of Copenhagen, Copenhagen, Denmark
| | - Roald Flesland Havre
- Endoscopy Unit, Copenhagen University Hospital/Herlev, University of Copenhagen, Copenhagen, Denmark
| | - Gro Linno Willemoe
- Department of Pathology, Copenhagen University Hospital/Righospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Meisner
- Endoscopy Unit, Copenhagen University Hospital/Herlev, University of Copenhagen, Copenhagen, Denmark
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21
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Mulabecirovic A, Vesterhus M, Gilja OH, Havre RF. In Vitro Comparison of Five Different Elastography Systems for Clinical Applications, Using Strain and Shear Wave Technology. Ultrasound Med Biol 2016; 42:2572-2588. [PMID: 27570209 DOI: 10.1016/j.ultrasmedbio.2016.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
Several different platforms providing ultrasound elastography have emerged in recent years. In this in vitro study on a single tissue-mimicking phantom (CIRS Model 49), we aimed to compare the performance of quantitative elastography measurements from platforms running strain elastography and others running shear wave elastography. We evaluated five different elastography platforms using both linear and curvilinear probes. All measurements were performed in parallel by two independent investigators who recorded the elasticity quantitatively. We investigated intra- and inter-observer agreement by intra-class correlation analysis and coefficient of variation, by correlation and limits of agreement. The reproducibility of elasticity measurements was good to excellent for shear wave and strain elastography. All five elastography platforms had high intra-observer (intra-class correlation coefficient: 0.932-1.0) and inter-observer correlation (intra-class correlation coefficient: 0.845-0.996). All inclusions could be differentiated by quantitative elastography by all systems (p < 0.001). The use of a linear probe yielded more reproducible measurements compared with use of a convex probe in 3/4 platforms.
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Affiliation(s)
- Anesa Mulabecirovic
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, N-5021 Bergen, Norway; Institute of Clinical Medicine, University of Bergen, N-5020, Bergen, Norway
| | - Mette Vesterhus
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, N-5021 Bergen, Norway; Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, N-5021 Bergen, Norway; Institute of Clinical Medicine, University of Bergen, N-5020, Bergen, Norway
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, N-5021 Bergen, Norway.
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22
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Mjelle AB, Mulabecirovic A, Hausken T, Havre RF, Gilja OH, Vesterhus M. Ultrasound and Point Shear Wave Elastography in Livers of Patients with Primary Sclerosing Cholangitis. Ultrasound Med Biol 2016; 42:2146-2155. [PMID: 27262519 DOI: 10.1016/j.ultrasmedbio.2016.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/21/2016] [Accepted: 04/26/2016] [Indexed: 06/05/2023]
Abstract
Point shear wave elastography (pSWE) is an ultrasound-based method for non-invasive quantification of liver fibrosis. The objective of this study was to explore liver pSWE in patients with primary sclerosing cholangitis (PSC) for assessment of fibrosis. Fifty-five non-transplant patients with PSC (38 males, 17 females; mean age: 46.4 y) were included and compared with 24 matched controls. Median (range) PSC duration was 8.1 (0-33) y. Ultrasonographic scanning followed by liver stiffness measurement by pSWE was performed using a conventional ultrasound system (Philips iU22). Signs of liver fibrosis on B-mode were identified in 21 patients (38%). Splenomegaly was found in 19 patients (35%) and ascites in two patients (4%). Successful pSWE measurements were achieved in the right liver lobe of all individuals and in the left liver lobe of 36 patients (65.5%). PSC patients had significantly higher median shear wave velocity (SWV) than controls in the right liver (median [range] SWV 1.26 [0.73-2.57] m/s vs. 1.09 [0.88-1.25] m/s, p < 0.001). SWV measured in the left liver lobe and spleen did not differ between PSC patients and controls. Our findings indicate that PSC patients have increased median SWV, indicating more fibrosis compared with controls; however, a wide range of SWV values were obtained among PSC patients, possibly reflecting the various stages in disease development.
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Affiliation(s)
- Anders Batman Mjelle
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anesa Mulabecirovic
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Trygve Hausken
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Mette Vesterhus
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway; Norwegian PSC Research Center, Division of Cancer Medicine, Surgery and Transplantation, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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23
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Tang SJ, Vilmann AS, Saftoiu A, Wang W, Streba C, Fink PP, Griswold M, Wu R, Dietrich CF, Jenssen C, Hocke M, Kantowski M, Pohl J, Fockens P, Annema JT, van der Heijden EH, Havre RF, Pham KDC, Kunda R, Deprez PH, Mariana J, Vazquez-Sequeiros E, Larghi A, Buscarini E, Fusaroli P, Lahav M, Puri R, Garg PK, Sharma M, Maluf-Filho F, Sahai A, Brugge WR, Lee LS, Aslanian HR, Wang AY, Shami VM, Markowitz A, Siddiqui AA, Mishra G, Scheiman JM, Isenberg G, Siddiqui UD, Shah RJ, Buxbaum J, Watson RR, Willingham FF, Bhutani MS, Levy MJ, Harris C, Wallace MB, Nolsøe CP, Lorentzen T, Bang N, Sørensen SM, Gilja OH, D’Onofrio M, Piscaglia F, Gritzmann N, Radzina M, Sparchez ZA, Sidhu PS, Freeman S, McCowan TC, de Araujo CR, Patel A, del Ali MA, Campbell G, Chen E, Vilmann P. EUS Needle Identification Comparison and Evaluation study (with videos). Gastrointest Endosc 2016; 84:424-433.e2. [PMID: 26873530 PMCID: PMC5570521 DOI: 10.1016/j.gie.2016.01.068] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. METHODS Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices. RESULTS There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001). CONCLUSIONS All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.
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Affiliation(s)
- Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Adrian Saftoiu
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, Craiova, Romania
| | - Wanmei Wang
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Costin Streba
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, Craiova, Romania
| | | | - Michael Griswold
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | | | | | | | - Jürgen Pohl
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | | | | | | | | | | | - Jinga Mariana
- University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | | | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Gurgaon, India
| | | | - Malay Sharma
- Jaswant Rai Speciality Hospital, Uttar Pradersh, India
| | | | - Anand Sahai
- Centre Hospitalier de l’Universite de Montreal, Canada
| | | | - Linda S. Lee
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Andrew Y. Wang
- University of Virginia Health System, Division of Gastroenterology and Hepatology, Charlottesville, Virginia, USA
| | - Vanessa M. Shami
- University of Virginia Health System, Division of Gastroenterology and Hepatology, Charlottesville, Virginia, USA
| | | | - Ali A. Siddiqui
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Girish Mishra
- Wake Forest University Hospital, Winston-Salem, North Carolina, USA
| | | | | | | | - Raj J. Shah
- University of Colorado Hospital, Denver, Colorado, USA
| | - James Buxbaum
- University of Southern California Keck School of Medicine, California, USA
| | | | | | | | | | | | | | | | - Torben Lorentzen
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Niels Bang
- Aarhus University Hospital, Aarhus, Denmark
| | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | | | - Maija Radzina
- Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Zeno Adrian Sparchez
- 3rd Medical Department, University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | | | | | | | | | - Akash Patel
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Garth Campbell
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Edward Chen
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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24
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Fusaroli P, Jenssen C, Hocke M, Burmester E, Buscarini E, Havre RF, Ignee A, Saftoiu A, Vilmann P, Nolsøe CP, Nürnberg D, D'Onofrio M, Gilja OH, Lorentzen T, Piscaglia F, Sidhu PS, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V - EUS-Guided Therapeutic Interventions (short version). Ultraschall Med 2016; 37:412-420. [PMID: 27490463 DOI: 10.1055/s-0035-1553742] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation (short version; the long version is published online).
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Affiliation(s)
- P Fusaroli
- Gastroenterology Unit, Department of Medical and Surgical Sciences University of Bologna,Hospital of Imola, Italy
| | - C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/ Wriezen, Germany
| | - M Hocke
- Dept of Internal Medicine 2, Helios Hospital Meiningen GmbH, Meiningen, Germany
| | - E Burmester
- Department of Internal Medicine I, Sana Kliniken, Luebeck, Germany
| | - E Buscarini
- UO Gastroenterologia, Ospedale Maggiore Crema, Italy
| | - R F Havre
- Department of Medicine and National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - A Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - A Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania and Department of Endoscopy, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Denmark
| | - P Vilmann
- Gastrointestinal Unit, Department of Surgery, University Hospital Herlev, Copenhagen, Denmark
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - M D'Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - F Piscaglia
- Unit of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna, Hospital S.Orsola Malpighi, Bologna, Italy
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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25
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Havre RF, Leh SM, Gilja OH, Ødegaard S, Waage JER, Baatrup G, Nesje LB. Differentiation of Metastatic and Non-Metastatic Mesenteric Lymph Nodes by Strain Elastography in Surgical Specimens. Ultraschall Med 2016; 37:366-372. [PMID: 27070128 DOI: 10.1055/s-0041-107975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To investigate if strain elastography could differentiate between metastatic and non-metastatic mesenteric lymph nodes ex-vivo. MATERIALS AND METHODS 90 mesenteric lymph nodes were examined shortly after resection from 25 patients including 17 patients with colorectal cancer and 8 patients with Crohn's disease. Ultrasound-based strain elastography was performed with a linear probe. Tissue hardness in lymph nodes was assessed using visual scales and measuring the strain ratio. B-mode characteristics were also recorded. Pathological diagnosis with grading of fibrosis served as the reference standard. RESULTS 20 lymph nodes were metastatic and 70 lymph nodes were non-metastatic. The strain ratios of metastatic and non-metastatic lymph nodes were significantly different (1.83 vs. 1.42, p = 0.021). The VAS scale (0 - 100) for tissue hardness gave higher mean values for metastatic than non-metastatic nodes, but the difference was not significant (65.5 vs. 55.0, p = 0.055). There was no difference between lymph nodes in Crohn's and non-metastatic cancer specimens. The metastatic lymph nodes were significantly more fibrotic than the non-metastatic lymph nodes by the ordinal fibrosis score (0 - 3). In an ROC analysis, quantitative strain imaging was not superior to the measurement of the short-axis diameter of lymph nodes in differentiating metastatic from non-metastatic mesenteric lymph nodes ex-vivo. CONCLUSION Strain elastography is correlated to fibrosis in lymph nodes and a significant difference was observed on a group level using the strain ratio. Due to measurement overlap, individual mesenteric lymph nodes could not be identified accurately as metastatic or not in this ex-vivo model by strain imaging alone.
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Affiliation(s)
- R F Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - S M Leh
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - O H Gilja
- Department of Medicine, Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
| | - S Ødegaard
- Department of Medicine, Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
| | - J E R Waage
- Department of Clinical Medicine, University of Bergen, Norway
| | - G Baatrup
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L B Nesje
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
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26
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Fusaroli P, Jenssen C, Hocke M, Burmester E, Buscarini E, Havre RF, Ignee A, Saftoiu A, Vilmann P, Nolsøe CP, Nürnberg D, D'Onofrio M, Gilja OH, Lorentzen T, Piscaglia F, Sidhu PS, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V. Ultraschall Med 2016; 37:77-99. [PMID: 26632995 DOI: 10.1055/s-0035-1553738] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation in clinical practice (long version).
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Affiliation(s)
- P Fusaroli
- Gastroenterology Unit, Department of Medical and Surgical Sciences University of Bologna/Hospital of Imola, Italy
| | - C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/ Wriezen, Germany
| | - M Hocke
- Department of Internal Medicine 2, Helios Hospital Meiningen GmbH, Meiningen, Germany
| | - E Burmester
- Department of Internal Medicine I, Sana Kliniken, Luebeck, Germany
| | - E Buscarini
- UO Gastroenterologia, Ospedale Maggiore Crema, Italy
| | - R F Havre
- Department of Medicine and National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - A Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - A Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania and Department of Endoscopy, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Denmark
| | - P Vilmann
- Gastrointestinal Unit, Department of Surgery, University Hospital Herlev, Copenhagen, Denmark
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - M D'Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - F Piscaglia
- Unit of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna/Hospital S.Orsola Malpighi, Bologna, Italy
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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27
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Jenssen C, Hocke M, Fusaroli P, Gilja OH, Buscarini E, Havre RF, Ignee A, Saftoiu A, Vilmann P, Burmester E, Nolsøe CP, Nürnberg D, D'Onofrio M, Lorentzen T, Piscaglia F, Sidhu PS, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV - EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version). Ultraschall Med 2016; 37:E33-E76. [PMID: 27058434 DOI: 10.1055/s-0035-1553785] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The fourth part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound describes general aspects of endoscopic ultrasound-guided diagnostic and therapeutic interventions and assesses the evidence for endoscopic ultrasound-guided sampling. Endoscopic ultrasound combines the most advanced high-resolution ultrasound imaging of lesions within the wall and in the vicinity of the gastrointestinal tract and safe and effective fine needle based tissue acquisition from these lesions. The guideline addresses the indications, contraindications, techniques, adverse events, training and clinical impact of EUS-guided sampling. Advantages and drawbacks are weighed in comparison with image-guided percutaneous biopsy. Based on the most current evidence, clinical practice recommendations are given for crucial preconditions and steps of EUS-guided sampling as well as for safe performance. Additionally, the guideline deals with the principles and reliability of cytopathological reporting in endoscopic ultrasound-guided sampling (long version).
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Affiliation(s)
- C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
| | - M Hocke
- Department of Internal Medicine 2, Helios Hospital Meiningen GmbH, Meiningen, Germany
| | - P Fusaroli
- Gastroenterology Unit, Department of Medical and Surgical Sciences University of Bologna/Hospital of Imola, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - E Buscarini
- Department of Gastroenterology and Endoscopy, Ospedale Maggiore Crema, Italy
| | - R F Havre
- Department of Medicine and National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - A Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - A Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania and Department of Endoscopy, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Denmark
| | - P Vilmann
- GastroUnit, Department of Surgery, University Hospital Herlev, Copenhagen, Denmark
| | - E Burmester
- Department of Internal Medicine I, Sana Kliniken, Luebeck, Germany
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - M D'Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, Italy
| | - T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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28
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Jenssen C, Hocke M, Fusaroli P, Gilja OH, Buscarini E, Havre RF, Ignee A, Saftoiu A, Vilmann P, Burmester E, Nolsøe CP, Nürnberg D, D'Onofrio M, Lorentzen T, Piscaglia F, Sidhu PS, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV - EUS-guided interventions: General Aspects and EUS-guided Sampling (Short Version). Ultraschall Med 2016; 37:157-169. [PMID: 26515966 DOI: 10.1055/s-0035-1553788] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The fourth part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound describes general aspects of endoscopic ultrasound-guided diagnostic and therapeutic interventions and assesses the evidence for endoscopic ultrasound-guided sampling. Endoscopic ultrasound combines the most advanced high-resolution ultrasound imaging of lesions within the wall and in the vicinity of the gastrointestinal tract and safe and effective fine needle-based tissue acquisition from these lesions. The guideline addresses the indications, contraindications, techniques, adverse events, training and clinical impact of EUS-guided sampling. Advantages and drawbacks are weighed in comparison with image-guided percutaneous biopsy. Based on the most current evidence, clinical practice recommendations are given for crucial preconditions and steps of EUS-guided sampling as well as for safe performance. Additionally, the guideline deals with the principles and reliability of cytopathological reporting in endoscopic ultrasound-guided sampling (short version; the long version is published online).
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Affiliation(s)
- C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
| | - M Hocke
- Department of Internal Medicine 2, Helios Hospital Meiningen GmbH, Meiningen, Germany
| | - P Fusaroli
- Gastroenterology Unit, Department of Medical and Surgical Sciences University of Bologna/Hospital of Imola, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - E Buscarini
- Departement of Gastroenterology and Endoscopy, Ospedale Maggiore Crema, Italy
| | - R F Havre
- Department of Medicine and National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - A Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - A Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania and Department of Endoscopy, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Denmark
| | - P Vilmann
- GastroUnit, Department of Surgery, University Hospital Herlev, Copenhagen, Denmark
| | - E Burmester
- Department of Internal Medicine I, Sana Kliniken, Luebeck, Germany
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - M D'Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, Italy
| | - T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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29
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Waage JER, Rafaelsen SR, Borley NR, Havre RF, Gubberud ET, Leh S, Kolbro T, Hagen KK, Eide GE, Pfeffer F. Strain Elastography Evaluation of Rectal Tumors: Inter- and Intraobserver Reproducibility. Ultraschall Med 2015; 36:611-617. [PMID: 25876223 DOI: 10.1055/s-0034-1398985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Elastography is a promising method for the identification and differentiation of malignant tissue in several organ systems. The primary aim was to evaluate the inter- and intraobserver reproducibility of endorectal strain elastography differentiation of adenomas and adenocarcinomas. The secondary aim was to compare the performance of strain elastography to endorectal ultrasonography (ERUS) examinations. MATERIALS AND METHODS Consecutive inclusion of 95 ERUS examinations and 110 elastography video loops with ERUS overlay mode. Video loops were randomized and evaluated by eight observers on two separate occasions. Observers were blinded to all clinical information except the circumferential location of the tumor. A continuous visual analog scale (VAS) and a categorical scale (W-score) were used for elastography evaluation. ERUS loops were T-staged according to the TNM classification system. Histopathological evaluation of surgical resection specimen was used as the reference standard. RESULTS Strain elastography visual evaluation yielded intraobserver variability from 0.86 to 0.97 and interobserver variability of 0.99. VAS strain elastography differentiation of adenomas (pT0) and adenocarcinomas (pT1 - 4) yielded sensitivity, specificity, accuracy, positive and negative predictive values of 0.94, 0.71, 0.89, 0.92 and 0.78, respectively. The corresponding ERUS values were 0.83, 0.64, 0.79, 0.88 and 0.54, respectively. CONCLUSION Visual evaluation of elastography loops is highly reproducible in an offline setting with blinded observers, and correlates significantly with pT-stages. Strain elastography performs better than ERUS and might consequently improve staging.
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Affiliation(s)
- J E R Waage
- Department of Clinical Medicine, University of Bergen, Norway
| | - S R Rafaelsen
- Department of Radiology, DCCG South Vejle Hospital, Vejle, Denmark
| | - N R Borley
- Department of Gastrointestinal Surgery, Cheltenham General Hospital, Cheltenham, UK
| | - R F Havre
- Department of Clinical Medicine, University of Bergen, Norway
| | - E T Gubberud
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - S Leh
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - T Kolbro
- Department of Surgery A, OUH Svendborg Hospital, Svendborg, Denmark
| | - K K Hagen
- Department of Surgery, Bispebjerg University Hospital, Copenhagen, Denmark
| | - G E Eide
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - F Pfeffer
- Department of Clinical Medicine, University of Bergen, Norway
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Sidhu PS, Brabrand K, Cantisani V, Correas JM, Cui XW, D'Onofrio M, Essig M, Freeman S, Gilja OH, Gritzmann N, Havre RF, Ignee A, Jenssen C, Kabaalioğlu A, Lorentzen T, Mohaupt M, Nicolau C, Nolsøe CP, Nürnberg D, Radzina M, Saftoiu A, Serra C, Spârchez Z, Sporea I, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Diagnostic Ultrasound-Guided Interventional Procedures (Long Version). Ultraschall Med 2015; 36:E15-E35. [PMID: 26669869 DOI: 10.1055/s-0035-1554036] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This is the second part of the series on interventional ultrasound guidelines of the Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). It deals with the diagnostic interventional procedure. General points are discussed which are pertinent to all patients, followed by organ-specific imaging that will allow the correct pathway and planning for the interventional procedure. This will allow for the appropriate imaging workup for each individual interventional procedure (Long version).
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Affiliation(s)
- P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - K Brabrand
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Norway
| | - V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - J M Correas
- Department of Adult Radiology, Paris-Descartes University and Necker University Hospital, Paris, and Institut Langevin - Inserm U979, Paris, France
| | - X W Cui
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - M D'Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, Italy
| | - M Essig
- Clinic of Gastroenterology, Departement Visceral Medicine, Inselspital, University Hospital of Bern, Switzerland
| | - S Freeman
- Department of Radiology, Derriford Hospital, Plymouth, UK
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
| | - N Gritzmann
- Radiology, Esslinger Hauptstraße 89, 1220 Vienna, Austria
| | - R F Havre
- Department of Medicine and National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - A Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
| | - A Kabaalioğlu
- Department of Radiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - M Mohaupt
- Department of Nephrology, Hypertension and Clinical Pharmacology, Division of Hypertension, University Hospital Berne, Switzerland
| | - C Nicolau
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - A Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - C Serra
- Diagnostic and Interventional Ultrasound Unit, Department of Organ Failure and Transplantation S. Orsola-Malpighi Hospital Bologna, Italy
| | - Z Spârchez
- Department of Gastroenterology, Institute for Gastroenterology and Hepatology, University of Medicine and Pharmacy, "Iuliu Hatieganu" Cluj-Napoca and Institute for Gastroenterology and Hepatology "O. Fodor" Cluj-Napoca, Romania
| | - I Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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Sidhu PS, Brabrand K, Cantisani V, Correas JM, Cui XW, D'Onofrio M, Essig M, Freeman S, Gilja OH, Gritzmann N, Havre RF, Ignee A, Jenssen C, Kabaalioğlu A, Lorentzen T, Mohaupt M, Nicolau C, Nolsøe CP, Nürnberg D, Radzina M, Saftoiu A, Serra C, Spârchez Z, Sporea I, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Diagnostic Ultrasound-Guided Interventional Procedures (Short Version). Ultraschall Med 2015; 36:566-580. [PMID: 26669871 DOI: 10.1055/s-0035-1566760] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This is the second part of the series on interventional ultrasound guidelines of the Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). It deals with the diagnostic interventional procedure. General points are discussed which are pertinent to all patients, followed by organ-specific imaging that will allow the correct pathway and planning for the interventional procedure. This will allow for the appropriate imaging workup for each individual interventional procedure (Long version/ short version; the long version is published online).
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Affiliation(s)
- P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - K Brabrand
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Norway
| | - V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - J M Correas
- Department of Adult Radiology, Paris-Descartes University and Necker University Hospital, Paris, and Institut Langevin - Inserm U979, Paris, France
| | - X W Cui
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - M D'Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, Italy
| | - M Essig
- Clinic of Gastroenterology, Departement Visceral Medicine, Inselspital, University Hospital of Bern, Switzerland
| | - S Freeman
- Department of Radiology, Derriford Hospital, Plymouth, UK
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
| | - N Gritzmann
- Radiology, Esslinger Hauptstraße 89, 1220 Vienna, Austria
| | - R F Havre
- Department of Medicine and National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - A Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
| | - A Kabaalioğlu
- Department of Radiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - M Mohaupt
- Department of Nephrology, Hypertension and Clinical Pharmacology, Division of Hypertension, University Hospital Berne, Switzerland
| | - C Nicolau
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - A Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - C Serra
- Diagnostic and Interventional Ultrasound Unit, Department of Organ Failure and Transplantation S. Orsola-Malpighi Hospital Bologna, Italy
| | - Z Spârchez
- Department of Gastroenterology, Institute for Gastroenterology and Hepatology, University of Medicine and Pharmacy, "Iuliu Hatieganu" Cluj-Napoca and Institute for Gastroenterology and Hepatology "O. Fodor" Cluj-Napoca, Romania
| | - I Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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Lorentzen T, Nolsøe CP, Ewertsen C, Nielsen MB, Leen E, Havre RF, Gritzmann N, Brkljacic B, Nürnberg D, Kabaalioglu A, Strobel D, Jenssen C, Piscaglia F, Gilja OH, Sidhu PS, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General Aspects (long Version). Ultraschall Med 2015; 36:E1-E14. [PMID: 26468774 DOI: 10.1055/s-0035-1553593] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This is the first part of the Guidelines on Interventional Ultrasound of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and covers all general aspects of ultrasound-guided procedures (long version).
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Affiliation(s)
- T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - M B Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - E Leen
- Imperial College London and Imaging Department, Hammersmith Hospital Campus, London, UK
| | - R F Havre
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - N Gritzmann
- Radiologist, Esslinger Hauptstraße 89, 1220 Wien, Austria
| | - B Brkljacic
- University of Zagreb School of Medicine, Department of Diagnostic and Interventional Radiology, University Hospital "Dubrava", Zagreb, Croatia
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - A Kabaalioglu
- Department of Radiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - D Strobel
- Department of Medicine I, University Hospital Erlangen, Germany
| | - C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna Hospital, Bologna, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen Norway and Department of Clinical Medicine, University of Bergen, Norway
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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Lorentzen T, Nolsøe CP, Ewertsen C, Nielsen MB, Leen E, Havre RF, Gritzmann N, Brkljacic B, Nürnberg D, Kabaalioglu A, Strobel D, Jenssen C, Piscaglia F, Gilja OH, Sidhu PS, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General Aspects (Short Version). Ultraschall Med 2015; 36:464-472. [PMID: 26468772 DOI: 10.1055/s-0035-1553601] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This is the first part of the Guidelines on Interventional Ultrasound of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and covers all general aspects of ultrasound-guided procedures (short version; the long version is published online).
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Affiliation(s)
- T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - M B Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - E Leen
- Imperial College London and Imaging Department, Hammersmith Hospital Campus, London, UK
| | - R F Havre
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - N Gritzmann
- Radiologist, Esslinger Hauptstraße 89, 1220 Wien, Austria
| | - B Brkljacic
- University of Zagreb School of Medicine, Department of Diagnostic and Interventional Radiology, University Hospital "Dubrava", Zagreb, Croatia
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - A Kabaalioglu
- Department of Radiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - D Strobel
- Department of Medicine I, University Hospital Erlangen, Germany
| | - C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna Hospital, Bologna, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen Norway and Department of Clinical Medicine, University of Bergen, Norway
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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Waage JER, Leh S, Røsler C, Pfeffer F, Bach SP, Havre RF, Haldorsen IS, Ødegaard S, Baatrup G. Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Dis 2015; 17:124-31. [PMID: 25407010 PMCID: PMC4312907 DOI: 10.1111/codi.12845] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 04/17/2014] [Indexed: 12/17/2022]
Abstract
AIM Strain elastography is a method for recording tissue hardness. Strain in different areas may be compared using strain ratio (SR). The aims of this study were to validate a previously proposed SR cut-off value of 1.25 for differentiating adenocarcinomas from adenomas and to compare the performance of endorectal ultrasonography (ERUS), strain elastography and MRI in the same patients. METHOD A prospective evaluation of 120 consecutive patients with rectal neoplasia, using a predetermined elastography strain ratio cut-off value, was performed to differentiate adenomas from adenocarcinomas. ERUS and MRI were performed according to standard routine at Haukeland University Hospital, defining T0 as adenomas and T1-T4 as adenocarcinomas. Subsequent histopathology was used as the reference standard. RESULTS Histopathological evaluation revealed 21 adenomas and 99 adenocarcinomas. Sensitivity, specificity and accuracy (with 95% CI) were as follows: ERUS: 0.96 (0.90-0.99), 0.62 (0.40-0.80) and 0.90 (0.83-0.94); elastography SR: 0.96 (0.90-0.99), 0.86 (0.66-0.96) and 0.94 (0.88-0.97); and MRI: 0.99 (0.94-1.00), 0.07 (0.00-0.31) and 0.87 (0.80-0.93). CONCLUSION This study confirms that the elastography SR assessment accurately differentiates sessile adenomas from adenocarcinomas. SR assessment has a superior ability to differentiate adenomas and adenocarcinomas when compared with ERUS and MRI. MRI examination seems unable to recognize adenomas and should be interpreted with care when early-stage rectal neoplasia is suspected.
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Affiliation(s)
- J E R Waage
- Department of Surgery, Haukeland University HospitalBergen, Norway,Department of Clinical Medicine, University of BergenBergen, Norway
| | - S Leh
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Pathology, Haukeland University HospitalBergen, Norway
| | - C Røsler
- Department of Radiology, Haukeland University HospitalBergen, Norway
| | - F Pfeffer
- Department of Surgery, Haukeland University HospitalBergen, Norway,Department of Clinical Medicine, University of BergenBergen, Norway
| | - S P Bach
- Academic Department of Surgery, Queen Elizabeth HospitalEdgbaston, Birmingham, UK
| | - R F Havre
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University HospitalBergen, Norway
| | - I S Haldorsen
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Radiology, Haukeland University HospitalBergen, Norway
| | - S Ødegaard
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University HospitalBergen, Norway
| | - G Baatrup
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Surgery A, Odense University HospitalSvendborg, Denmark,Institute for Regional Health Science, University of Southern DenmarkOdense, Denmark
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Waage JER, Bach SP, Pfeffer F, Leh S, Havre RF, Ødegaard S, Baatrup G. Combined endorectal ultrasonography and strain elastography for the staging of early rectal cancer. Colorectal Dis 2015; 17:50-6. [PMID: 25176033 DOI: 10.1111/codi.12764] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/27/2014] [Indexed: 12/22/2022]
Abstract
AIM Strain elastography is a novel approach to rectal tumour evaluation. The primary aim of this study was to correlate elastography to pT stages of rectal tumours and to assess the ability of the method to differentiate rectal adenomas (pT0) from early rectal cancer (pT1-2). Secondary aims were to compare elastography with endorectal ultrasonography (ERUS) and to propose a combined strain elastography and ERUS staging algorithm. METHOD In all, 120 consecutive patients with a suspected rectal tumour were examined in this staging study. Patients receiving surgery without neoadjuvant radiotherapy were included (n = 59). All patients were examined with ERUS and elastography. Treatment decisions were made by multidisciplinary team (MDT) assessment, without considering the strain elastography examination. RESULTS Histopathology identified 21 adenomas, 13 pT1, 9 pT2, 15 pT3 and one pT4. Mean elastography strain ratios were predictive of T stage (P = 0.01). Differentiation of adenomas from early rectal cancer (pT1-2) had sensitivity, specificity and accuracy of 0.82, 0.86 and 0.84 for elastography and 0.82, 0.62 and 0.72 for ERUS. A combined staging algorithm was developed to identify tumours eligible for local resection. Based on MDT evaluation 32% of tumours later identified as pT0 or pT1 were treated with total mesorectal excision, even though a local excision might have sufficed. Combined ERUS and elastography evaluation would have significantly reduced this number to 9% (P = 0.008). CONCLUSION Elastography may improve the staging of adenomas and early rectal cancer compared with ERUS alone. Combined ERUS and elastography assessment is likely to further improve the selection of patients for local resection.
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Affiliation(s)
- J E R Waage
- Department of Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Abstract
OBJECTIVES. The aim of this study was to evaluate the diagnostic potential of strain assessment in solid focal pancreatic lesions using real-time elastography in combination with endoscopic ultrasonography (EUS). MATERIAL AND METHODS. Forty-eight solid focal pancreatic lesions in 39 patients were included prospectively over a 3-year period and studied by EUS with real-time elastography (EUS-RTE). Lesions previously described as cystic by CT were not included. Distribution patterns of tissue strain were assessed using strain ratio (SR) measurements, continuous visual analog scale (VAS), and a visual categorical score (VCS), based on color coding of relative strain. Final diagnosis was based on histopathology, fine-needle aspiration cytology, and/or follow-up for ≥6 months. RESULTS. The 48 lesions included 11 adenocarcinomas, 7 malignant neuroendocrine tumors (NETs), 11 benign or indeterminate NETs, 8 focal pancreatic lesions, 2 microcystic adenomas, and 9 other benign lesions. Malignant lesions had significantly higher median SR (7.05 vs. 1.56) and VAS scores (93.0 vs. 63.5) than benign lesions. A receiver operation characteristic curve analysis showed sensitivity of 67% and specificity of 71%, when using SR = 4.4 as a cut-off for malignancy. The highest SR values were found in two benign microcystic adenomas. CONCLUSIONS. EUS-RTE with SR measurements and VAS evaluation demonstrated a significant strain difference between benign and malignant lesions. However, the variation within the entities was substantial and some benign lesions presented with low strain. Benign lesions were generally characterized by a strain similar to reference tissue, whereas malignant lesions were harder. The recorded strain pattern in individual lesions must be interpreted with caution.
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Affiliation(s)
- Roald Flesland Havre
- Department of Medicine, Haukeland University Hospital , Jonas Lies vei, Bergen , Norway
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Havre RF, Leh S, Gilja OH, Ødegaard S, Waage JE, Baatrup G, Nesje LB. Strain assessment in surgically resected inflammatory and neoplastic bowel lesions. Ultraschall Med 2014; 35:149-158. [PMID: 23154869 DOI: 10.1055/s-0032-1325535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To investigate whether ultrasound-based strain imaging can discriminate between colorectal adenocarcinomas and stenotic Crohn's lesions in newly resected surgical specimens. MATERIALS AND METHODS Resected surgical specimens from 27 patients electively operated for colorectal tumors or stenotic lesions from Crohn's disease were prospectively examined with ultrasonography using a Hitachi HV 900 US scanner with real-time elastography (RTE). Three different methods were applied to assess tissue strain: A four-level categorical visual classification, a continuous visual analog scale (VAS, 0 - 100) and a strain ratio (SR) measurement between the lesion and surrounding reference tissue. The imaged sections were marked and subsequently examined by a pathologist. Results from RTE were evaluated according to diagnosis, degree of fibrosis, inflammatory parameters, tumor stage and grade. RESULTS 16 sections from Crohn's lesions, 18 sections from adenocarcinomas and 4 sections from adenomas were examined. Both adenocarcinomas and Crohn's lesions were found to be harder than the surrounding tissue, but they could not be discriminated from each other by any of the strain imaging evaluation methods. All adenocarcinomas had significantly higher strain ratios than adenomas. The categorical classification differentiated poorly between Crohn's lesions, adenocarcinomas and adenomas. Categorical evaluation and VAS score showed fair interobserver agreement. SR measurements provided semi-quantitative strain data and added improved information about elasticity properties, despite substantial intra-observer variation. CONCLUSION Sonoelastography with SR measurements and visual evaluation of strain differences could not differentiate stenotic Crohn's lesions from adenocarcinomas in resected bowel specimens. A small number of adenomas were found to be significantly softer than adenocarcinomas using the same evaluation methods. The tumor stage or grade did not have a significant impact on the elastography results.
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Affiliation(s)
- R F Havre
- Institute of Medicine, University of Bergen
| | - S Leh
- The Gade Institute, University of Bergen
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Institute of Medicine, Bergen
| | - S Ødegaard
- Institute of Medicine, University of Bergen
| | - J E Waage
- Department of Surgery, Haukeland University Hospital, Bergen
| | - G Baatrup
- Institute of Surgery, University of Bergen
| | - L B Nesje
- Institute of Medicine, University of Bergen
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Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas JM, Gilja OH, Klauser AS, Sporea I, Calliada F, Cantisani V, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Fromageau J, Havre RF, Jenssen C, Ohlinger R, Săftoiu A, Schaefer F, Dietrich CF. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 2013; 34:238-53. [PMID: 23605169 DOI: 10.1055/s-0033-1335375] [Citation(s) in RCA: 461] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The clinical part of these Guidelines and Recommendations produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology EFSUMB assesses the clinically used applications of all forms of elastography, stressing the evidence from meta-analyses and giving practical advice for their uses and interpretation. Diffuse liver disease forms the largest section, reflecting the wide experience with transient and shear wave elastography . Then follow the breast, thyroid, gastro-intestinal tract, endoscopic elastography, the prostate and the musculo-skeletal system using strain and shear wave elastography as appropriate. The document is intended to form a reference and to guide clinical users in a practical way.
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Affiliation(s)
- D Cosgrove
- Div. of Radiology, Imperial and Kings Colleges, London, UK.
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Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med 2013; 34:169-84. [PMID: 23558397 DOI: 10.1055/s-0033-1335205] [Citation(s) in RCA: 690] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The technical part of these Guidelines and Recommendations, produced under the auspices of EFSUMB, provides an introduction to the physical principles and technology on which all forms of current commercially available ultrasound elastography are based. A difference in shear modulus is the common underlying physical mechanism that provides tissue contrast in all elastograms. The relationship between the alternative technologies is considered in terms of the method used to take advantage of this. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided on optimisation of scanning technique, image display, image interpretation and some of the known image artefacts.
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Affiliation(s)
- J Bamber
- Ultrasound and Optics Team, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, United Kingdom.
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von Volkmann HL, Havre RF, Løberg EM, Haaland T, Immervoll H, Haukeland JW, Hausken T, Gilja OH. Quantitative measurement of ultrasound attenuation and Hepato-Renal Index in Non-Alcoholic Fatty Liver Disease. Med Ultrason 2013; 15:16-22. [PMID: 23486619 DOI: 10.11152/mu.2013.2066.151.hlv1qmu2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this study was to non-invasively explore new methods of ultrasound attenuation measurements in livers of patients with Non-Alcoholic-Fatty-Liver-Disease (NAFLD) and to measure the liver tissue elasticity. MATERIAL AND METHOD Sixteen patients with NAFLD, twelve patients with liver fibrosis and fifteen healthy subjects were included. Echo Levels (ELs) in dB were measured at 2 and 7 cm depths in the right liver to calculate the attenuation. ELs were measured in liver and right kidney tissue to calculate the Hepato-Renal Index (HRI). This index was calculated both as a difference, HRI-diff; (EL Liver -EL Kidney) and HRI-ratio; (EL Liver / EL Kidney) using built-in software of the ultrasound scanner. Liver tissue elasticity was measured using transient elastography (TE, Fibroscan®). NAFLD and liver fibrosis were confirmed by liver biopsy. RESULTS We found that HRI- diff was significantly higher in the NAFLD group compared with healthy subjects, 6.2 dB (0.8-11.4) vs.1. 9 dB (0.0-6.1), p=0.012. HRI- ratio was significantly lower between the same two groups, 0.9 dB (0.8-1.02) vs.1.01 dB (0.9-1.12), and p<0.0001. TE, ELs and liver size showed significant differences between NAFLD patients and healthy controls. Between patients with fibrosis and NAFLD the differences were significant for TE, liver size and attenuation. Intra- and interobserver correlation and agreement of ELs were good. CONCLUSION Measurements of liver tissue using HR-Indexes, ultrasound attenuation, and tissue elasticity may be useful methods to differentiate objectively between steatosis and healthy and quantify the differences.
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Havre RF, Waage JR, Gilja OH, Ødegaard S, Nesje LB. Real-Time Elastography: Strain Ratio Measurements Are Influenced by the Position of the Reference Area. Ultraschall Med 2012; 33:559-568. [PMID: 21667433 DOI: 10.1055/s-0031-1273247] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Real-time elastography (RTE) is an ultrasound-based method for the visualization of relative strain distribution in soft tissues. Strain ratio is a semi-quantitative measurement of strain differences between two user-defined areas in an elastogram. The aim of this study was to evaluate the impact of the size and location of a reference area when measuring the strain ratio of focal lesions in a tissue-mimicking phantom and in normal liver tissue. We also investigated whether the strain ratio was affected by changing the scanner parameter: elasticity dynamic range (E-dyn). MATERIALS AND METHODS Two investigators individually collected data by scanning 4 spherical inclusions with different elasticity in a phantom in which the elastic modulus was known in both the lesions and the background. Subsequently, a liver scan was performed in-vivo using the same scanning protocol. Five different setups with changes in reference area position or size were tested. All eight levels of the scanner setting Edyn were recorded for each setup and the strain ratio was measured in 3 different representative elastograms for each recording situation. RESULTS The four inclusions had significantly different mean strain ratio levels (p < 0.01) when compared to the surrounding material. Changing the position of the reference area to a deeper position influenced the strain ratio measurements significantly for all phantom lesions and in the liver. Changing the size of the reference area, while keeping the center depth unchanged, did not influence the mean strain ratio levels significantly. The strain ratio was independent of the E-dyn parameter setting. The intraand interobserver reliability was high when measuring the strain ratio with a free-hand technique. CONCLUSION Strain ratio provides reproducible measurements of inclusions representing different elastic contrasts using a free-hand technique in vitro. Changes in the distance of the reference areas to the ultrasound probe, representing the stress source, seem to have a significant impact on strain ratio measurements.
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Affiliation(s)
- R F Havre
- Institute of Medicine, University of Bergen
| | - J R Waage
- Department of Surgery, Haukeland University Hospital
- Institute of Surgery, University of Bergen
| | - O H Gilja
- Institute of Medicine, University of Bergen
- Department Of Medicine, Haukeland University Hospital, National Center for Ultrasound in Gastroenterology
| | - S Ødegaard
- Institute of Medicine, University of Bergen
- Department Of Medicine, Haukeland University Hospital, National Center for Ultrasound in Gastroenterology
| | - L B Nesje
- Institute of Medicine, University of Bergen
- Department Of Medicine, Haukeland University Hospital, National Center for Ultrasound in Gastroenterology
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Abstract
AIM Real-time elastography visualizes tissue compliance using an ultrasound platform. Elastography has been used, particularly in the breast, to characterize indeterminate lesions on B-mode imaging as either benign or malignant. The primary aim of this study was to assess the feasibility of routine endorectal elastography to evaluate rectal neoplasia. The secondary aim was to correlate elastography data with histopathological end-points. METHOD Sixty-nine patients referred to the outpatient clinic of the Department of Colorectal Surgery at Haukeland University Hospital for the evaluation of rectal tumours were included in this prospective cohort study. All patients underwent digital rectal examination, rigid rectoscopy with biopsy, endorectal ultrasonography and endorectal elastography. In each case a strain ratio was calculated, comparing the tumour tissue with adjacent reference tissue that appeared normal on ultrasound scanning. RESULTS Histopathologically there were 23 adenomas and 45 adenocarcinomas. One patient died before surgical treatment. Adequate elastography images were obtained in 66/69 (96%) patients. Optimal discrimination of malignant and benign lesions was obtained using a strain ratio cut-off value of 1.25 (sensitivity, 0.93; specificity, 0.96; and accuracy, 0.94). CONCLUSION Endorectal elastography can be performed as an integral part of the clinical evaluation of rectal tumours and has good patient compliance. The method is a promising modality for the discrimination between adenocarcinoma and adenoma of the rectum.
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Affiliation(s)
- J E R Waage
- Department of Surgery, Haukeland University Hospital, Bergen, Norway.
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Affiliation(s)
- S Odegaard
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
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Havre RF, Elde E, Gilja OH, Odegaard S, Eide GE, Matre K, Nesje LB. Freehand real-time elastography: impact of scanning parameters on image quality and in vitro intra- and interobserver validations. Ultrasound Med Biol 2008; 34:1638-1650. [PMID: 18524458 DOI: 10.1016/j.ultrasmedbio.2008.03.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 02/09/2008] [Accepted: 03/10/2008] [Indexed: 05/26/2023]
Abstract
Real-time elastography is a method for visualization of the elastic properties of soft tissue and may potentially enable differentiation between malignant and benign pathologic lesions. Our aim was to validate the method on a tissue-mimicking (TM) phantom and to evaluate the influence of different scanning parameters and investigator variability. A TM-phantom containing eight spherical inclusions with known storage modulus was examined using two different transducers on an ultrasound (US) scanner equipped with software for real-time elasticity imaging. The ultrasound transducers were moved vertically in a repetitive manner to induce strain. Two investigators performed series of standardized elastography scans applying a 0-4 categorical quality scale to evaluate the influence of seven parameters: dynamic range of elasticity, region-of-interest, frequency of transducer movement, rejection of elastogram noise, frame rate, persistence and smoothing. Subsequently, repeated examinations of four selected inclusions were performed using a visual analog scale (VAS) where investigators marked a 100 mm horizontal line representing the span in image quality based on experience from the first examination. The hardest and softest inclusions were imaged more clearly than the inclusions with elasticity more similar to the background material. Intraobserver agreement on elastogram quality was good (kappa: 0.67 - 0.75) and interobserver agreement average (kappa: 0.55 - 0.56) when using the categorical scale. The subsequent VAS evaluation gave intraclass-correlation coefficients for the two observers of 0.98 and 0.93, respectively, and an interclass-correlation coefficient of 0.93. Real-time elastography adequately visualized isoechoic inclusions with different elastic properties in a TM-phantom with acceptable intra- and interobserver agreement. Dynamic range of elasticity was the parameter with most impact on the elastographic visualization of inclusions.
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Affiliation(s)
- Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
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