The use of contrast-enhanced ultrasound (CEUS) in adults is well established in many different areas, with a number of current applications deemed "off-label", but the use supported by clinical experience and evidence. Paediatric CEUS is also an "off-label" application until recently with approval specifically for assessment of focal liver lesions. Nevertheless there is mounting evidence of the usefulness of CEUS in children in many areas, primarily as an imaging technique that reduces exposure to radiation, iodinated contrast medium and the "patient-friendly" circumstances of ultrasonography. This position statement of the European Federation of Societies in Ultrasound and Medicine (EFSUMB) assesses the current status of CEUS applications in children and makes suggestions for further development of this technique.

The purpose was to analyse the aetiology and ultrasound appearances of segmental testicular infarction. Patients with focal testicular lesions underwent colour Doppler high frequency ultrasound. Segmental testicular infarction was defined as any focal area of altered reflectivity, with or without focal enlargement with absent or diminished colour Doppler flow, proven on histology or on follow-up exclusion of lesion progression. Patients were reviewed to document lesion shape, position, border definition, reflectivity and vascularity and correlated to presenting clinical symptoms and signs. Over a 6-year period 24 patients were defined as having segmental testicular infarction; median age was 37 years (range 16-82 years). All presented with a sudden onset of testicular pain. Of the patients, 14/24 (58.3%) had scrotal inflammatory disease, 5/24 (20.8%) had evidence of spermatic cord torsion, and three patients were termed idiopathic; 12/24 (50.0%) were of low reflectivity, 11/24 (45.8%) of mixed reflectivity, one of high reflectivity, 11/24 (45.8%) were wedge shaped, and 13/24 (54.2%) were round shaped. Of the patients, 8/24 (33.3%) demonstrated a mass effect, all with round-shaped lesions and with underlying epididymo-orchitis in seven. Absent colour Doppler flow was demonstrated in 20/24 (83.3%). Histology confirmed infarction in 8/24 (33.3%), and 12/24 (50.0%) had follow-up examinations without progression of the lesions. Segmental testicular infarction has characteristic ultrasound features, not always wedge-shaped, with reduced or absent vascularity of key importance. Awareness of the ultrasound features will allow for conservative management and avoid unnecessary orchidectomy.

Pediatric CEUS is a safe and potentially cost-effective imaging modality. Using it allows reduction in the ionizing radiation associated with CT and in the gadolinium contrast administration, sedation, and anesthesia sometimes required for MRI.

These findings demonstrate the usefulness of CEUS in characterizing indeterminate grey-scale sonography FLL in pediatric patients with the potential to reduce exposure to ionizing radiation.

The introduction of ultrasound contrast agents has rendered contrast-enhanced ultrasound (CEUS) a valuable complementary technique to address clinically significant problems. This pictorial review describes the use of CEUS guidance in abdominal intervention and illustrates such application for a range of clinical indications. Clinical application of CEUS discussed include commonly performed abdominal interventional procedures, such as biopsy, drainage, nephrostomy, biliary intervention, abdominal tumor ablation and its subsequent monitoring, and imaging of vascular complications following abdominal intervention. The purpose of this article is to further familiarize readers with the application of CEUS, particularly its specific strength over alternative imaging modalities, in abdominal intervention.

A series of 7 testicular epidermoid cysts were imaged by contrast-enhanced sonography to assess internal vascularity and by real-time tissue elastography to grade stiffness by a visual and strain ratio quantification scoring system. No internal vascular enhancement was seen on contrast-enhanced sonography; the 3 largest lesions showed rim enhancement. On the real-time elastographic color display, all lesions were predominantly blue ("hard"), and the lesions analyzed for the strain ratio had a mean value of 43.57. Contrast-enhanced sonography depicts the absence of vascular flow, and real-time elastography shows that the epidermoid cysts are hard. This combination of information will help further characterize these lesions.

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Ultrasonography (US) is an established modality for intervention. The introduction of microbubble US contrast agents (UCAs) has the potential to further improve US imaging for intervention. According to licensing, UCAs are currently approved for clinical use in restricted situations, but many additional indications have become accepted as having clinical value. The use of UCAs has been shown to be safe, and there is no risk of renal toxic effects, unlike with iodinated or gadolinium contrast medium. Broadly speaking, UCAs can be injected into the bloodstream (intravascular use) or instilled into almost any accessible body cavity (endocavitary use), either in isolation or synchronously. In microvascular applications, contrast-enhanced US (CEUS) enhances delineation of necrotic areas and the vascularized target to improve real-time targeting. The ability of CEUS to allow true assessment of vascularity has also been used in follow-up of devascularizing intervention. In macrovascular applications, real-time angiographic images can be obtained with CEUS without nephrotoxic effects or radiation. In endocavitary applications, CEUS can achieve imaging similar to that of iodinated contrast medium-based fluoroscopy; follow-up to intervention (eg, tubography and nephrostography) can be performed at the bedside, which may be advantageous. The use of UCAs is a natural progression in US-guided intervention. The aim of this article is to describe the indications, contraindications, and techniques of using UCAs as an adjunctive tool for US-guided interventional procedures to facilitate effective treatment, improve complication management, and increase the overall success of interventional procedures. Online supplemental material is available for this article. RSNA, 2016.