VP63.11: Contrast‐enhanced ultrasound imaging of uterine disorders: a systematic review

Contrast-enhanced ultrasound (CEUS) has the ability to visualise the microvasculature by means of intravascular contrast agents. The clinical added value of CEUS has been established in liver, kidney and cardiac imaging, but its value in gynecology still has to be demonstrated. The aim of this systematic review is to provide an overview on the use of CEUS in diagnosing uterine disorders, i.e. fibroids, adenomyosis, leiomyosarcomas and endometrial carcinomas, as well as for monitoring and enhancing the effectiveness of minimally invasive therapies such as high-intensity focused ultrasound and embolisation treatment. Systematic review of papers in PubMed, EMBASE and Cochrane computerised bibliographic databases for eligible studies. Peer reviewed studies including RCTs, prospective and retrospective cohort and case-control studies with more than 10 patients were eligible. When available, contrast-enhancement ultrasound characteristics for the tissue studied, data on diagnostic accuracy, sensitivity, specificity, negative and positive predictive value, interclass correlation coefficient was extracted or calculated. 26 studies met our inclusion criteria. The results entail a detailed description of contrast-enhancement characteristics of different types of tissue, providing a basis for diagnostic differentiation in gynecology. CEUS readily showed to be applicable for monitoring of therapies and predicting the best treatment option. This review also shows the limited number of methodological high-quality clinical studies and structural reports on CEUS application in gynecology. CEUS is a promising diagnostic tool, however, if we aim at an established role of CEUS in daily gynecological practice, we should make a joined effort in setting up methodological high-quality clinical studies with appropriate reference testing, and report contrast-enhancement characteristics and quantitative parameters in a consistent manner.