EFSUMB Newsletter 89

Ultraschall in Med 2013; 34

Winner of EUROSON 2012 Young Investigator Award

Dose-Dependent Artefact in the far Wall of the Carotid Artery with Dynamic Contrast Enhanced Ultrasound

EFSUMB NewsletterEuropean Federation of Societies for Ultrasound in Medicine and Biology

EFSUMB

Lynne Rudd28 Portland Place, London W1B 1LY, United Kingdom Tel: +44 (0) 20 7099 7140 Email: efsumb@efsumb.org

Introduction ▼

Dynamic contrast enhanced ultrasound (DCE-US) is an emerging technology to assess neovascularization in atherosclero-sis. The aim of this study was to quantify a pseudo-enhancement phenomenon ob-served during DCE-US of the carotid in other studies.

Methods ▼

Ethical approval was obtained for this pro-spective case series and each patient gave written informed consent. 31 patients with 50–99 % internal carotid artery ste-nosis underwent DCE-US imaging of the carotid bifurcation using 2 ml of intrave-nous SonoVue™. In the final 10 patients, a further 1 ml bolus was administered after 15 minutes. Raw linear DICOM data was analysed offline. Regions of interest were drawn within the common carotid lumen and immediately adjacent in the near and far wall adventitia. Peak intensity was measured. In addition, an in vitro experi-ment, using a single channel flow phan-

tom was performed. SonoVue™ concent-rations of 0.02, 0.1, 0.5, 1, and 2 ‰ were pumped into the tube. Regions of interest were drawn in a similar fashion and the peak intensity measured.

Results ▼

The carotid far wall was significantly more echogenic than the near wall at 2 ml (p < 0.0001, n = 31) and the far wall inten-sity rose synchronously with that of the lumen. The intensity difference was a fac-tor of 4 at 1 ml and 12 at 2 ml. In vitro, the phantom demonstrated a similar pattern and magnitude of enhancement in an area without vasa vasorum.

Conclusion ▼

A dose-dependent, non-linear propaga-tion artefact occurs in the far wall adven-titia of the carotid artery, which should not be mistaken as a marker of plaque vul-nerability.

Recent Awards2010 Royal College of Surgeons Mary

Dunhill Fellowship2010 Circulation Foundation Mary

Davies Fellowship2011 UK Venous Forum Travelling

Fellowship2011 London Surgical Symposium

1st Prize2012 EUROSON Young Investigator

Award EFSUMB2012 Graham-Dixon Prize for Cardio-

vascular Surgery

Ankur Thapar (UK) BSc, MBBS, MRCS

Ankur Thapar is a year 1 vascular surgery trai-nee with an interest in novel ultrasound tech-niques for imaging the carotid artery and ju-gular vein. Ankur trained at Imperial College London and is currently completing his PhD in functional ultrasound imaging of vulnera-ble carotid plaque.

All National Societies are reminded to submit their nomination for this year’s Young Investigator Award for a chance to win the coveted title and 1000 euro at EUROSON 2013, Stuttgart, Germany.

EFSUMB Newsletter90

Ultraschall in Med 2013; 34

Report of EFSUMB Activities in 2012 from EFSUMB President Fabio Piscaglia During last year activities have been ac-tively running and the following are some of the most relevant topics:

▶ For the first time the EUROSON mee-ting took place in Spain (Madrid). This was a successful event, with the con-junct participation of different specia-lity societies, together with the multi-disciplinary Spanish society.

▶ The CEUS non liver guidelines were published in the first 2012 issue of our official journal „Ultraschall in der Medizin / European Journal of Ultra-sound“, dispatched to all EFSUMB members. At the end of the year the CEUS liver guidelines went e-pub. The latter were published simultanously in our journal and in the journal of the WFUMB, to represent the joint efforts of these two Federations to produce the document.

▶ The preparation of Technological and Clinical Recommendations on the use of ultrasound Elastography has been ongoing during the whole year and is expected to be published online and subsequentely to appear in a printed version within 2013. Part 1 of the document will deal with the basics of ultrasound elastography, aimed at clarifying the different modalities currently on the market, which produ-ce different types of elastography, in-cluding strain elastography and vari-ous shear wave modalities. Part 2 will present the current recommended clinical applications. This document will keep EFSUMB at the forefront of ultrasound worldwide, being the first guidelines released by a multidiscipli-nary ultrasound society.

▶ The European Course Book was finally printed and is now available to be or-dered. This book is, in the opinion of the EFSUMB officers, an outstanding production, with an extremely good quality / cost ratio, as it can be read for free from the EFSUMB website and but is also rather cheap to be purchased as a printed book with colour figures.

▶ The EFSUMB website has been enri-ched constantly. The case of the month receives many thousand visits per month and is now translated in several languages. New cases from all EFSUMB members are welcome and can provi-de great visibility to the authors.

▶ EFSUMB has proposed a new term, Echoscopy, for bedside focused, clini-cally simple applications than can be carried out also with pocket size scan-ners. A more detailed EFSUMB posi-tion on this topic, very relevant for everybody, but expecially for clinici-ans, is reported in this newsletter.

▶ More information of EFSUMB activities to the individual national members is expected. To this aim EFSUMB has asked its delegates to inform all national members about EFSUMB activities in 2013 in their own national languages.

▶ In 2012 the EFSUMB Education Com-mittee approved 8 Euroson Schools in 5 countries, with a successful Elasto-graphy School held in Athens, Greece, for the first time and the year ended with the Hannover CEUS School which is now so popular the course is over-subscribed. The EPSC endorsed 11 courses from Peru to Romania, the latter offering an impressive 6 en-dorsed courses during the year.

▶ Educational activities carried out within the EFSUMB mainframe are to be adequately recognized. Therefore EFSUMB decided to start releasing EFSUMB educational credits to ack-nowledge participation in its educa-tional activities. Recognition of these credits by a national agency is not guaranteed and should be specifically verified (a universal recognition is in fact impossible on a European basis, given the different systems active in different countries, which are not mutually recognized).

▶ Online education continues with the postgraduate web course which can be completed online to receive the EFSUMB CME certificate.

▶ The Executive Bureau activities are carried out on a regular basis, thanks also to the support of Internet suppor-ted Conference Calls, which allow meetings on nearly a monthly basis with no additional cost. This modality is being experimented also by the EFSUMB Committees.

▶ EFSUMB was represented at various meetings ECR, UEG Week, EASL and Dreilandertreffen in 2012 to promote our activities.

▶ The Educational Portal hosts two e.Pub books which can be downloaded for free; Hepatic Elastography using Ultra-sound Waves, edited by Prof Ioan Sporea and Dr Roxana Sirli and The Safe Use of Ultrasound in Medical Diagnosis, edited by Dr Gail ter Haar.

▶ A position statement on safety of elastography has been released by the ECMUS Committee.

We look forward to working closely with our National Societies in 2013 to continue building the European ultrasound commu-nity.

Fabio Piscaglia

EFSUMB Newsletter 91

Ultraschall in Med 2013; 34

Meetings between the two Societies have already been held in Vienna, both during the WFUMB / EFSUMB Congress and du-ring the congress of ESR. The first com-bined scientific session will be at the Austria Center in Vienna, during the Eu-ropean Congress of Radiology (ECR) 2013. It will be on Monday, March 11, 2013; 08:30–10:00; Room Z, and will be en-titled:

„Advances in diagnostic ultrasound: better results through cooperation”

During the meetings, discussions have been held on a variety of topics. Among them the problem of archiving ultrasound images and reports. From a survey held by the ESR, it has been shown that the ultra-sound images (obtained either in radio-logy or in clinical departments) are not always routinely saved in the hospital PACS systems and that, within the same hospital, the reports of the ultrasound examinations are often recorded in a vari-ety of archives. It has been recognized that it may be difficult to find resources to link all US equipment to the IT hospital system and to provide enough memory to store large amounts of data, especially if video clips need to be recorded. It has also been considered that there may be problems in planning a uniform and complete storage of the examinations’ reports, since ultra-sound may be used in a large variety of

Dear Colleagues

EFSUMB Recently Joined in a Collaboration with the European Society of Radiology (ESR)

ways, from a stand-alone study to a simp-le and quick guide to a procedure or a phy-sical exam. However, it has been agreed that availability of ultrasound images and reports for future reference is quite im-portant in clinical practice and it has been decided that both Societies would recom-mend to their members to organize their ultrasonography workflow so that proper archiving of all examinations performed within each hospital would be regularly obtained.The main aim of the collaboration bet-ween the two Societies is to further pro-mote both clinical and radiological Ultra-sound. In the following we want to suggest to our EFSUMB members the advantages of being an ESR member. The European Society of Radiology currently boasts 53,822 members in good standing from 195 countries. This makes the ESR one of the most important institutions in the field of radiology, aiming to promote radiology and highlight its importance in medicine worldwide.

Education & Training ▼

ESR offers a wide range of learning and training opportunities in accordance with its mission to promote diagnostic and interventional radiology and associ-ated disciplines through pre and postgra-duate education and research, and to for-mulate teaching and examination pro-grammes to provide equivalent training for radiologists and other staff working in radiology departments in the relevant countries. ESR has an extensive home-page (http://www.myesr.org) where all the courses can be viewed. In this eLear-ning has a prominent place. All ESR members have free and unlimited access to the online version of European Radiology, the official journal of ESR, which in 2010 has reached a Impact Factor of 3.594 and is Europe‘s no. 1 general ra-diological journal. The printed version of European Radiology can be purchased by ESR members for only an extra fee. A print subscription includes 12 monthly issues

and around 2,500 pages of scientific con-tent.

Research ▼

Created in order to provide a Europe-wide base for joint research, EIBIR, the Euro-pean Institute for Biomedical Imaging Research, aims to ensure the pooling of resources among members, to promote a culture of cooperation through networ-king activities. EIBIR thus wants to gene-rate critical mass and help coordinate research into new instrumentation, me-thods, concepts and technologies.

Publications & Media ▼

Through its various publications in print as well as in electronic format, ESR provi-des its members and partners with valu-able information about and insights into all aspects of radiology-related and socie-ty matters. Scientific publications include European Radiology, Insights into Imaging and ESR publications and statements and various ESR and ECR media.

EU Affairs ▼

The ESR is closely monitoring EU legisla-tion and EU affairs with a potential im-pact on medical imaging and has started to successfully build relations with rele-vant EU institutions and EU consulting and public affairs agencies. The ESR needs to be acknowledged as a major stakehol-der in EU health policies and involved in consultation processes for new legislative initiatives in this field. In order to achieve this, the ESR has adopted a pro-active ap-proach and has recently established an EU Taskforce.

ECR ▼

The annual Congress takes place each year in the beginning of March in Vienna and as a member can be attended at a reduced fee.

Univ. Prof. Dr. Norbert Gritzmann Former President of EFSUMB

Prof. Michael Bachmann Nielsen EFSUMB Publications Committee Chairman

Introducing the EFSUMB: the world’s largest ultrasound Society

N. Gritzmann (Vienna / AT)

ESR / EFSUMB collabora-tion: a newly establis-hed platform for joint development of ultra-sound in radiology and clinical specialties

L.E. Derchi (Genoa / IT)

Image fusion and inter-vention

T. Lorentzen (Herlev / DK)

The EFSUMB non-liver CEUS guidelines

F. Piscaglia (Bo-logna / IT)

The EFSUMB / WFUMB liver CEUS guidelines

M. Claudon (Vandoeuvre-les-Nancy / FR)