Enhancing the role of paediatric ultrasound with microbubbles: a review of intravenous applications

Abstract

Contrast-enhanced ultrasound (CEUS) represents a complementary technique to greyscale and colour Doppler ultrasonography which allows for real-time visualization and characterization of tissue perfusion. Its inherent advantages in the child makes ultrasonography an ideal imaging modality; repeatability and good tolerance along with the avoidance of CT, a source of ionizing radiation, renders ultrasonography imaging desirable. Although currently paediatric CEUS is principally used in an "off-label" manner, ultrasonography contrast agents have received regulatory approval for assessment of paediatric focal liver lesions (FLL) in the USA. The safety of ultrasound contrast-agents is well documented in adults, as safe as or even surpassing the safety profile of CT and MR contrast agents. Except for the established intracavitary use of CEUS in voiding urosonography, i.v. paediatric applications have been introduced with promising results in the abdominal trauma initial diagnosis and follow-up, characterization and differential diagnosis of FLL and characterization of lung, pleura, renal and splenic pathology. CEUS has also been used to detect complications after paediatric transplantation, evaluate inflammatory bowel disease activity and assess tumour response to antiangiogenic therapy. The purpose of this review was to present these novel i.v. paediatric applications of CEUS and discuss their value.

Static and Dynamic Ultrasound Imaging to Visualize the Bladder, Bladder Neck, Urethra, and Pelvic Floor in Children with Daytime Incontinence

“…New US techniques for visualization of complex anatomy are successfully being introduced into pediatric urology ( 14 ). Contrast-enhanced US using agents like microbubbles is such an example ( 33 ). At the same time, exact relations between imaging outcomes and clinical symptoms remain unclear.…”

Contrast-enhanced ultrasound (CEUS) in abdominal intervention

“…Lumason (Bracco Diagnostics; Monroe Township, NJ) has received regulatory approval for pediatric hepatic use for assessment of pediatric focal liver lesions in the United States [ 10 , 77 ]. Pediatric CEUS has also been extensively in an “off-label” manner [ 78 ] for further indications [ 79 ] with promising results, such as in abdominal trauma [ 75 ] and in established endocavitary use in voiding urosonography [ 21 ]. Furthermore, CEUS-guided pediatric intervention has been reported for chest drainage [ 80 ].…”

Contrast‐Enhanced Ultrasound for identifying circulatory complications after liver transplants in children

“…Nevertheless, as in the adult population, recommendations for the pediatric population are in fact in place . A recently published review concludes that CEUS can confidently detect important postoperative complications in the pediatric liver transplantation population …”