Fabio Piscaglia

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.

Contrast enhanced colour/power Doppler US: 1. Can be utilised for further assessment of the degree of vascularisation in joints of patients with rheumatoid arthritis. (Recommendation Level: C;2b) 2. Repeat contrast enhanced Doppler US may provide useful information on the response to treatment, to guide therapeutic strategy. The technique has the potential to be utilised within dedicated centres using standardised methodology. (Recommendation Level: C

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.