Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesions - infectious (bacterial).

In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of bacterial infections are discussed. Improved detection and characterization of common focal liver lesions (FLL) are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper on infectious (bacterial) focal liver lesions is on their appearance on B-mode and Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.

Inflammatory activity in Crohn's disease: CE-US.

The evaluation of inflammatory activity in Crohn's disease (CD), a crucial aspect of treatment planning and monitoring, is currently based on a sum of clinical data and imaging findings. Among the contrast enhanced cross-sectional imaging techniques (CE-US, CE-CT, CE-MR), CE-US is less invasive, more comfortable for the patient, and has significant diagnostic accuracy. In addition, it is a portable, easily repeatable, well tolerated, and ionizing radiation-free imaging modality. CE-US has been introduced as effective method in the quantitative and qualitative evaluation of CD inflammatory activity. CE-US might help in characterizing bowel-wall thickening by differentiating inflammatory neovascularisation, edema, and fibrosis. The recent chance to evaluate the bowel-wall stiffness by US elastography imaging could allow further assessment of fibrosis that characterizes the evolution of the inflammatory activity.