EFSUMB Newsletter
EFSUMB Newsletter European Federation of Societies for Ultrasound in Medicine and Biology
Prof Paul Sidhu, EFSUMB President Elect
New EFSUMB Statement on Paediatric CEUS As most of you will be aware, the FDA in the United States took the unprecedented step of approving an ultrasound contrast agent (Lumason™ / SonoVue™) for use not only in the adult patient with a focal liver lesion but also in the paediatric population. Clinical trials for the adult patient were conducted in the United States but no such paediatric trial was performed, and in fact there has been no clinical trial anywhere in the world to address this issue. The decision of the FDA was based entirely on safety data provided by European centres, where CEUS in children has been performed for a number of years with success. Numerous European based studies have reported the usefulness of this technique in liver, and elsewhere particularly in the management of blunt abdominal trauma in the child. There is no justification to subject the child to repeat CT examinations when the CEUS examination is so accurate in isolated solid abdominal organ injury.
The granting of a licence for the use of an ultrasound contrast agent in the United States will alter medical practice worldwide – ultrasound practitioners will be less hesitant in using ultrasound contrast agents in the child. The safety profile is well established in adults and will be similar in the child. With this development EFSUMB has commissioned a position statement on the use of CEUS in children, bringing together vast experience across Europe in aspects of CEUS application in children, culminating in a 10 page document summarizing this experience and advocating expanded uses of CEUS in children. This is ready and has been accepted for publication in the European Journal of Ultrasound; and is now available on-line. The statement covers the use of CEUS in focal liver lesions, blunt abdominal trauma and voiding cystourography – the 3
main areas of application currently. The statement speculates on the limited evidence in niche areas and predicts those applications that will increase and deliver useful clinical information. We expect this statement to benchmark the application of CEUS in children worldwide. As ever, EFSUMB is grateful to the team of experts who committed time and energy to drafting this position statement, working rapidly and diligently over a short period of time. Congratulations to the whole of the EFSUMB ultrasound community who in many ways contributed to the expertise presented in the guidelines, by pushing innovation and exploring the application of ultrasound for the benefit and safety of patients. Prof Paul Sidhu London, UK
EFSUMB Lynne Rudd 28 Portland Place, London W1B 1LY, United Kingdom Tel: +44 (0) 20 7099 7140 Email: efsumb@efsumb.org There is still time to apply to the following Schools with topics on CEUS, MSK, Elastography and EUS.
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EFSUMB Newsletter
Euroson School and consensus meeting in Gastrointestinal Ultrasound (GIUS) Gargnano, Italy, April 21-23 The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) arranged for the first time a Euroson School dedicated to ultrasound of the intestines. The location of the course was the small, picturesque town of Gargnano by Lake Garda in Italy. Approximately 60 participants from several European countries as well as Asia and North America participated. The course directors were Giovanni M aconi (Italy) and Odd Helge Gilja (Norway).
Gastrointestinal ultrasound (GIUS) has for many years been advocated as a useful tool for assessing acute and chronic gastrointestinal diseases, but is still not a part of daily clinical practice in many hospitals. This could probably be explained by the general view amongst clinicians that this is a highly specialized field of ultrasonography for experts only – although the course organizers stated this to be incorrect. One of the aims of this course was to present and discuss suggestions for a standar-
dization of examination methods and scoring systems for separating normal from abnormal intestinal ultrasound findings. The many lecturers from all over Europe were all experts in different fields of GIUS; giving a thorough and broad introduction to the field, with many clinical examples and didactic ultrasound videos. Elastography, particularly its ability to distinguish fibrosis from active intestinal inflammation, and Contrast Enhanced Ultrasound (CEUS) was also covered; the
Dr. Kim Nylund (Bergen) is demonstarting bowel ultrasound on a patient with IBD at the hands-on session.
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The course Directors Giovanni Maconi (Milan) and Odd Helge Gilja (Bergen) present the program and GIUS concept at the opening of the course.
latter being useful in diagnosing inflammatory processes, abscesses, and the route of fistulas. Of course, endoscopic ultrasound and the feasibility of Doppler in diagnostics were also covered; the latter useful in diagnosing active intestinal wall inflammation as vascularity increases. Another highlight was the long sessions of hands-on training on patients in small groups, getting real “first-hand-experience” with the tool and the topic, being taught by the foremost experts in Europe. Just after the course experts from all over Europe sat down to discuss new EFSUMB guidelines on GIUS. A Task force group is working to establish new clinical recommendations within various fields of gastrointestinal ultrasound. At the upcoming EUROSON in Leipzig there will be a special session on GIUS covering many important aspects of methodology and clinical applications. Eline Lundekvam Storlid, Odd Helge Gilja