Intravenous contrast-enhanced sonography in children and adolescents – a single center experience

Abstract

Compared to adult patients, ultrasonography in children and adolescents is much more common, due to lack of ionizing radiation, and its wide availability. With the introduction of contrast-media for use in ultrasonography, one major drawback of the method could be overcome. In Europe, SonoVue® is the only widely available agent, which due to improved stability makes it possible to image normal and diseased tissue perfusion and vascularization with high accuracy. Inability to hold the breath and voluntary body movement of the patient is less of an obstacle compared to color Doppler techniques and makes the method very attractive for use in children, which, depending on age, may not be very cooperative. Use of intravenous contrast-medium in minors is currently very limited for several reasons: availability, lack of recommendation in national and international guidelines, and lack of official licensing. The article will touch medical indications, technique, safety considerations, and perspective of intravenous use of contrast-media in children and adolescents, including data from a 6-year period in 37 patients.PurposeThe purpose of the study was to collect data on ultrasonographic examinations, expanded by intravenous administration of the contrast agent SonoVue® in children and adolescents. Besides assessing diagnostic yield, data on adverse medication effects was collected.Materials and methodsThe study includes contrast-enhanced ultrasound examinations in 37 children at a single institution. Indications for the examinations were tumor lesions, infections, traumatic organ injuries, and parenchymal organ ischemia. Parents of the patients and adolescent patients were informed about the off-label use of the contrast agent. Thirty-nine examinations were performed, the average age of the patient was 11.1 years (range 1 to 17 years).ResultsAll of the examinations yielded additional diagnostic value, always expanding results from B mode and color coded sonography. Overall, most examinations were done to assess the liver (n=16), followed by the kidney in 10 cases. The different etiologies were encountered in the following order: tumor (n=22), infection (n=9), trauma (n=5), ischemia (n=4). Most examinations were performed to evaluate a hepatic lesion (n=12). There was one incident recorded that fit the criteria of a possible adverse effect. In an 8-year-old girl nausea was noted, that started 15 minutes after the end of the examination and resolved spontaneously. In none of the patients medical treatment for adverse effects was necessary.ConclusionUltrasonography in children, enhanced by intravenous use of contrast medium is feasible and allows for further evaluating cystic and solid tumors, and organ perfusion. Given that proper medical equipment and correct ultrasound machine settings are used, it is a robust method without diagnostic failures. In this small-sized case series there were no severe adverse effects, however, off-label use in children needs to be addressed.

Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement

“…Management consisted of oxygen, intravenous epinephrine and fluids (0.9 % normal saline) with resolution in two hours. In 37 children who underwent intravenous CEUS, an 8-year-old girl reported nausea 15 minutes after UCA administration, which continued for 30 minutes [27]. In addition, a retrospective survey analysis of 948 examinations (29 European centres) all performed with SonoVue™/Lumason™, five minor adverse events were recorded; skin reaction, unusual taste and hyperventilation were observed [28].…”

“…In published studies of paediatric liver CEUS with SonoVue™/Lumason™, the volume of a single SonoVue™/Lumason™ dose ranges between 0.1 mL to 4.8 mL. The volume of the administered UCA is extrapolated from the licensed adult dose for liver applications and has been described to be adjusted according to child's age, body surface or body weight in the case of obese children as well as the type of US scanner, transducer and processing software used e. g. (a) 0.1 mL of SonoVue™/Lumason™ for each year of age [27] and (b) standard single dose of 0.1 mL, 0.5 mL, 1 mL, 1.2 mL, 2.4 mL or 4.8 mL of SonoVue™/Lumason™ [44 -47]. The recommendation of the FDA for the dose of SonoVue™/Luma-son™ in children is based on body weight; 0.03 mL/kg as an intravenous injection, up to a maximum of 2.4 mL per injection [23].…”

“…In total 4 original paediatric studies including 125 children (newborn to 18 years old) have been conducted for evaluation of FLL [21,27,45,46]. The largest series of FLL evaluated with CEUS to date described 44 children (median age 11.5 years) evaluated for the characterization of FLL detected during B-mode US imaging [45].…”

Contrast-enhanced US Assessment of Focal Liver Lesions in Children

“…An increased dose may also be required when structures with small vessels or relatively little blood flow, as compared with the liver or other large abdominal organs, are imaged (3). The following are the most commonly proposed dosing schemes for sulfur hexafluoride lipid-type A microspheres: (a) 0.6 mL for children younger than 6 years, 1.2 mL for children aged 6-12 years, and 2.4 mL for children older than 12 years (23); (b) 0.1 mL per each year of age (24); (c) 0.1 mL/kg for children weighing up to 24 kg and the standard dose of 2.4 mL for children weighing more than 24 kg (25); and (d) fixed doses of 0.1, 0.5, 1.2, 2.4, and 4.8 mL each (6,26,27).…”

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

“…We administer 0.6 ml in children ,6 years old, 1.2 ml in children between 6 and 12 years of age and 2.4 ml in children .12 years of age. Other suggested dosage schemes are as follows: (a) 0.1 ml of SonoVue™ for every year of age 14 and (b) standard single doses of 0.1, 0.5, 1.0, 1.2, 2.4 and 4.8 ml of SonoVue™. [15][16][17] The microbubbles are administered through an i.v.…”