Contrast-enhanced ultrasonography in children

Abstract

Development of ultrasound contrast agents (UCAs) opened the possibility of a new radiation-free diagnostic technique called contrast-enhanced ultrasonography (CEUS) in pediatric imaging. First, the safety profile of CEUS is discussed, followed by the description of common clinical applications. UCAs are not registered for individuals younger than 18 years and their current use is off-label. The published studies concerning UCA safety have shown the high safety profile of UCAs. Following intravenous application of UCAs, only one severe anaphylactic reaction has been reported in children, along with some mild adverse reactions, while during intravesical application no adverse effect related to UCAs has been reported. The main indication in the pediatric population for UCA application is voiding urosonography (VUS). The generally accepted standard VUS procedure is described together with its role in the urodiagnostic algorithm. The intravenous application of UCA is less widespread, but it is slowly gaining popularity among pediatric radiologists as a problem solving method. Unfortunately, there has been no standardization of the procedure and there are no official recommendations regarding the dose of UCAs, which should be appropriately adjusted according to the patient's weight or age, and to the probe. The review of the published literature concerning intravenous CEUS is presented. A step forward towards functional imaging is dynamic CEUS, which enables quantification of enhancement. In addition, the role of the EFSUMB Paediatric Registry Data Base is presented. Conclusion -CEUS examinations have opened new prospects in ultrasound and have become promising non-invasive radiation-free method in children,

Updates on some current issues in paediatric imaging

“…Since the introduction to the market of more stable second generation ultrasound contrast agents, together with the introduction of harmonic ultrasound imaging, the technique of contrast enhanced voiding urosonography has proven to be valid and sensitive, in experienced hands, and is the procedure of choice in many central European countries to detect vesicoureteric reflux. The review papers in this issue give a detailed account of the technique, and discuss the safety issues together with the advantages of its use (4,5). While the relationship between urinary tract infection, vesicoureteric reflux and renal scarring remains controversial, and the indications for studies to detect reflux are decreasing, it is important where possible to use examinations which are not associated with radiation exposure.…”

Paediatric contrast-enhanced ultrasonography: A challange with a promising future

“…Ključevšek D. was the author of the review paper "Contrast-enhanced ultrasonography in children" and Cvitković Roić A, et al of "Contrast-enhanced voiding urosonography (CeVus) as a diagnostic tool in evaluation of vesicoureteral reflux" (1,2).…”