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. Der technische Teil dieser Leitlinien und Empfehlungen, der unter der Federführung der EFSUMB entstanden ist, enthält eine Einleitung zu allen physikalischen Grundlagen und Methoden der aktuell kommerziell erhältlichen Ultraschall-Elastografie-Technologien. Unterschiede in der Schersteifigkeit sind der wesentliche physikalische Mechanismus, dem der Gewebekontrast in allen Elastogrammen zu Grunde liegt. Die Beziehung zu alternativen Technologien wird und die Vorteile der angewandten Methode herausgearbeitet. Die praktischen Vorteile und Nachteile jeder Technik werden beschrieben und Empfehlungen zur Optimierung der Scantechnik, der Bildqualität und der Bildinterpretation gegeben, ebenso werden einige der bekannten Artefakte dargestellt.

The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.

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. Der klinische Teil dieser unter der Schirmherrschaft der EFSUMB erstellten Richtlinien und Empfehlungen beurteilt die klinisch genutzten Anwendungen aller Formen der Elastografie, betont die Evidenz von Meta-Analysen und gibt praktische Hinweise in Bezug auf Einsatz und Interpretation der Elastografie. Die diffusen Lebererkrankungen nehmen den größten Teil ein und spiegeln somit die umfangreiche Erfahrung in der transienten und der ShearWave-Elastografie wider. Es folgen Brust, Schilddrüse, Gastrointestinaltrakt, endoskopische Elastografie, Prostata und Muskel-Skelett-System unter Verwendung von Strain und gegebenenfalls ShearWave-Elastografie. Diese Publikation soll als Empfehlung dienen und klinische Anwender auf praktische Art anleiten.

We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography, focused on the assessment of diffuse liver disease. The first part (long version) of these Guidelines and Recommendations deals with the basic principles of elastography and provides an update of how the technology has changed. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided regarding optimization of scanning technique, image display, image interpretation, reporting of data and some of the known image artefacts. The second part provides clinical information about the practical use of elastography equipment and the interpretation of results in the assessment of diffuse liver disease and analyzes the main findings based on published studies, stressing the evidence from meta-analyses. The role of elastography in different etiologies of liver disease and in several clinical scenarios is also discussed. All of the recommendations are judged with regard to their evidence-based strength according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both beginners and advanced clinical users.

“How to perform contrast-enhanced ultrasound (CEUS)” provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for optimal CEUS performance. CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience. The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.

Context The prevalence of thyroid nodules in the general population is increasingly high, and at least half of those biopsied prove to be benign. Sonographic risk-stratification systems are being proposed as “rule-out” tests that can identify nodules that do not require fine-needle aspiration cytology (FNA). Objective To comparatively assess the performances of 5 internationally endorsed sonographic classification systems (those of the American Thyroid Association [ATA], the American Association of Clinical Endocrinologists [AACE], the American College of Radiologists [ACR], the European Thyroid Association [EU-TIRADS], and the Korean Society of Thyroid Radiology [K-TIRADS]) in identifying nodules whose FNA can be safely deferred and to estimate their negative predictive values (NPV). Design Prospective study of thyroid nodules referred for FNA. Setting Single academic referral center. Patients 477 patients (358 females, 75.2%), mean (SD) age 55.9 (13.9) years Main Outcome Measures Number of biopsies classified as unnecessary, false-negative rate, sensitivity, specificity, predictive values, and diagnostic odds ratios, for each system. Results Application of the systems’ FNA criteria would have reduced the number of biopsies performed by 17.1–53.4%. The ACR TIRADS allowed the largest reduction (268/502) with the lowest FNR (NPV 97.8%, 95% CI 95.2-99.2%). Except for the K-TIRADS, all other systems exhibited significant discriminatory performance but produced significantly smaller reductions in the number of procedures. Conclusions Internationally-endorsed sonographic risk stratification systems vary widely in their ability to reduce the number of unnecessary thyroid nodule FNAs. The ACR TIRADS outperformed the others, classifying over half the biopsies as unnecessary with a FNR of 2.2%.