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Ultrasound
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Ultrasound Contrast Agents and Technique
CEUS Technique: Dynamic CEUS Quantification
CEUS Technique: Dynamic CEUS Quantification
Stephanie R. Wilson, MD; Benjamin A. Caine, BMSc; Alexandra Medellin, MD
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KEY FACTS

  • Terminology

    • Clinical Implications

      • CLINICAL APPLICATIONS OF DCE-US

        TERMINOLOGY

        • Definitions

          • Time-intensity curves (TIC) are formed by calculating change in mean signal intensities within defined region of interest (ROI)
            • TIC reflects wash-in and washout of contrast agent within manually drawn ROI
            • Mean signal intensity within ROI is calculated in linear units, displayed as function of time
          • TIC can be generated with logarithmic or linear display and are related by following formula
            • Logarithmic value = 10 x log(linear value)
            • Linear value = 10^(logarithmic value/10)
          • All time and contrast enhancement intensity parameters are calculated using fitted curve and are not derived from raw image data
          • Time parameters include
            • Time of arrival (TOA): Time from injection of contrast agent to arrival of microbubbles in ROI
              • TOA is also referred to as time zero offset (t)
            • Wash-in time (WIT): Time interval from TOA to peak enhancement (PE)
            • Rise time (RT): Time frame during which intensity varies from 5-95% or 10-90% of PE (or possibly from TOA to PE, depending on software used)
            • Wash-out time (WOT): Time from maximum intensity until total washout
            • Mean transit time (MTT): Mean time taken for microbubble passage through ROI
          • Intensity parameters include
            • PE: Maximum intensity of enhancement on TIC, recorded at peak of arterial-phase enhancement and measured in arbitrary intensity units (AIU)
          • Combined parameters include
            • Area under curve (AUC): Area below time-intensity curve
              • AUC is calculated using linear curve and is combined sum of all instant peak enhancement levels on fitted curve
            • Wash-in rate (WiR): Tangent of wash-in slope
            • Washout rate (WoR): Tangent of washout slope

        CLINICAL IMPLICATIONS

        • Clinical Importance

          Clinical Applications of DCE-US

          • Monitoring Antiangiogenic Therapy in Neoplasia

            • Monitoring Inflammatory Activity in IBD

              DCE-US TECHNIQUE

              • Procedure and Imaging Considerations

                • Pitfalls and Challenges of DCE-US in IBD

                  • Pitfalls and Challenges of DCE-US in Neoplasia

                    Selected References

                    1. Medellin A et al: Role of contrast-enhanced ultrasound in evaluation of the bowel. Abdom Radiol (NY). 43(4):918-933, 2018
                    2. Wilkens R et al: Persistent enhancement on contrast-enhanced ultrasound studies of severe Crohn's disease: stuck bubbles? Ultrasound Med Biol. 44(11):2189-2198, 2018
                    3. Medellin-Kowalewski A et al: Quantitative contrast-enhanced ultrasound parameters in Crohn disease: their role in disease activity determination with ultrasound. AJR Am J Roentgenol. 206(1):64-73, 2016
                    4. Bolzacchini E. Dynamic contrast-enhanced ultrasonography (DCE-US): current and future applications in Oncology. European Society Rad. 2015
                    5. Fröhlich E et al: Dynamic contrast-enhanced ultrasound for quantification of tissue perfusion. J Ultrasound Med. 34(2):179-96, 2015
                    6. Hudson JM et al: Dynamic contrast enhanced ultrasound for therapy monitoring. Eur J Radiol. 84(9):1650-7, 2015
                    7. Weskott, H. Contrast-Enhanced Ultrasound. Bremen: UNI-MED, 2013
                    8. Zocco MA et al: Early prediction of response to sorafenib in patients with advanced hepatocellular carcinoma: the role of dynamic contrast enhanced ultrasound. J Hepatol. 59(5):1014-21, 2013
                    9. De Franco A et al: Ileal Crohn disease: mural microvascularity quantified with contrast-enhanced US correlates with disease activity. Radiology. 262(2):680-8, 2012
                    10. Dietrich CF et al: An EFSUMB introduction into dynamic contrast-enhanced ultrasound (DCE-US) for quantification of tumour perfusion. Ultraschall Med. 33(4):344-51, 2012
                    11. Gauthier TP et al: Perfusion quantification using dynamic contrast-enhanced ultrasound: the impact of dynamic range and gain on time-intensity curves. Ultrasonics. 51(1):102-6, 2011
                    12. Greis C: Quantitative evaluation of microvascular blood flow by contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc. 49(1-4):137-49, 2011
                    13. Lassau N et al: Dynamic contrast-enhanced ultrasonography (DCE-US) and anti-angiogenic treatments. Discov Med. 11(56):18-24, 2011
                    14. Tang MX et al: Quantitative contrast-enhanced ultrasound imaging: a review of sources of variability. Interface Focus. 1(4):520-39, 2011
                    15. Quaia E et al: The diagnostic value of small bowel wall vascularity after sulfur hexafluoride-filled microbubble injection in patients with Crohn's disease. Correlation with the therapeutic effectiveness of specific anti-inflammatory treatment. Eur J Radiol. 69(3):438-44, 2009
                    16. Medellin-Kowalewski et al: Contrast-enhanced US in Inflammatory Bowel Disease: An Occasional or an Essential Component of Every Exam? Presented at the Radiological Society of North America 2012 Scientific Assembly and Annual Meeting. Chicago, Illinois, 2012
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                    References
                    Tables

                    Tables

                    KEY FACTS

                    • Terminology

                      • Clinical Implications

                        • CLINICAL APPLICATIONS OF DCE-US

                          TERMINOLOGY

                          • Definitions

                            • Time-intensity curves (TIC) are formed by calculating change in mean signal intensities within defined region of interest (ROI)
                              • TIC reflects wash-in and washout of contrast agent within manually drawn ROI
                              • Mean signal intensity within ROI is calculated in linear units, displayed as function of time
                            • TIC can be generated with logarithmic or linear display and are related by following formula
                              • Logarithmic value = 10 x log(linear value)
                              • Linear value = 10^(logarithmic value/10)
                            • All time and contrast enhancement intensity parameters are calculated using fitted curve and are not derived from raw image data
                            • Time parameters include
                              • Time of arrival (TOA): Time from injection of contrast agent to arrival of microbubbles in ROI
                                • TOA is also referred to as time zero offset (t)
                              • Wash-in time (WIT): Time interval from TOA to peak enhancement (PE)
                              • Rise time (RT): Time frame during which intensity varies from 5-95% or 10-90% of PE (or possibly from TOA to PE, depending on software used)
                              • Wash-out time (WOT): Time from maximum intensity until total washout
                              • Mean transit time (MTT): Mean time taken for microbubble passage through ROI
                            • Intensity parameters include
                              • PE: Maximum intensity of enhancement on TIC, recorded at peak of arterial-phase enhancement and measured in arbitrary intensity units (AIU)
                            • Combined parameters include
                              • Area under curve (AUC): Area below time-intensity curve
                                • AUC is calculated using linear curve and is combined sum of all instant peak enhancement levels on fitted curve
                              • Wash-in rate (WiR): Tangent of wash-in slope
                              • Washout rate (WoR): Tangent of washout slope

                          CLINICAL IMPLICATIONS

                          • Clinical Importance

                            Clinical Applications of DCE-US

                            • Monitoring Antiangiogenic Therapy in Neoplasia

                              • Monitoring Inflammatory Activity in IBD

                                DCE-US TECHNIQUE

                                • Procedure and Imaging Considerations

                                  • Pitfalls and Challenges of DCE-US in IBD

                                    • Pitfalls and Challenges of DCE-US in Neoplasia

                                      Selected References

                                      1. Medellin A et al: Role of contrast-enhanced ultrasound in evaluation of the bowel. Abdom Radiol (NY). 43(4):918-933, 2018
                                      2. Wilkens R et al: Persistent enhancement on contrast-enhanced ultrasound studies of severe Crohn's disease: stuck bubbles? Ultrasound Med Biol. 44(11):2189-2198, 2018
                                      3. Medellin-Kowalewski A et al: Quantitative contrast-enhanced ultrasound parameters in Crohn disease: their role in disease activity determination with ultrasound. AJR Am J Roentgenol. 206(1):64-73, 2016
                                      4. Bolzacchini E. Dynamic contrast-enhanced ultrasonography (DCE-US): current and future applications in Oncology. European Society Rad. 2015
                                      5. Fröhlich E et al: Dynamic contrast-enhanced ultrasound for quantification of tissue perfusion. J Ultrasound Med. 34(2):179-96, 2015
                                      6. Hudson JM et al: Dynamic contrast enhanced ultrasound for therapy monitoring. Eur J Radiol. 84(9):1650-7, 2015
                                      7. Weskott, H. Contrast-Enhanced Ultrasound. Bremen: UNI-MED, 2013
                                      8. Zocco MA et al: Early prediction of response to sorafenib in patients with advanced hepatocellular carcinoma: the role of dynamic contrast enhanced ultrasound. J Hepatol. 59(5):1014-21, 2013
                                      9. De Franco A et al: Ileal Crohn disease: mural microvascularity quantified with contrast-enhanced US correlates with disease activity. Radiology. 262(2):680-8, 2012
                                      10. Dietrich CF et al: An EFSUMB introduction into dynamic contrast-enhanced ultrasound (DCE-US) for quantification of tumour perfusion. Ultraschall Med. 33(4):344-51, 2012
                                      11. Gauthier TP et al: Perfusion quantification using dynamic contrast-enhanced ultrasound: the impact of dynamic range and gain on time-intensity curves. Ultrasonics. 51(1):102-6, 2011
                                      12. Greis C: Quantitative evaluation of microvascular blood flow by contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc. 49(1-4):137-49, 2011
                                      13. Lassau N et al: Dynamic contrast-enhanced ultrasonography (DCE-US) and anti-angiogenic treatments. Discov Med. 11(56):18-24, 2011
                                      14. Tang MX et al: Quantitative contrast-enhanced ultrasound imaging: a review of sources of variability. Interface Focus. 1(4):520-39, 2011
                                      15. Quaia E et al: The diagnostic value of small bowel wall vascularity after sulfur hexafluoride-filled microbubble injection in patients with Crohn's disease. Correlation with the therapeutic effectiveness of specific anti-inflammatory treatment. Eur J Radiol. 69(3):438-44, 2009
                                      16. Medellin-Kowalewski et al: Contrast-enhanced US in Inflammatory Bowel Disease: An Occasional or an Essential Component of Every Exam? Presented at the Radiological Society of North America 2012 Scientific Assembly and Annual Meeting. Chicago, Illinois, 2012