Safety of contrast-enhanced ultrasound in children for non-cardiac applications: a review by the Society for Pediatric Radiology (SPR) and the International Contrast Ultrasound Society (ICUS)

Abstract

The practice of contrast-enhanced ultrasound in children is in the setting of off-label use or research. The widespread practice of pediatric contrast-enhanced US is primarily in Europe. There is ongoing effort by the Society for Pediatric Radiology (SPR) and International Contrast Ultrasound Society (ICUS) to push for pediatric contrast-enhanced US in the United States. With this in mind, the main objective of this review is to describe the status of US contrast agent safety in non-cardiac applications in children. The five published studies using pediatric intravenous contrast-enhanced US comprise 110 children. There is no mention of adverse events in these studies. From a European survey 948 children can be added. In that survey six minor adverse events were reported in five children. The intravesical administration of US contrast agents for diagnosis of vesicoureteric reflux entails the use of a bladder catheter. Fifteen studies encompassing 2,951 children have evaluated the safety of intravesical US contrast agents in children. A European survey adds 4,131 children to this group. No adverse events could be attributed to the contrast agent. They were most likely related to the bladder catheterization. The existing data on US contrast agent safety in children are encouraging in promoting the widespread use of contrast-enhanced US.

The Pediatric Kidney

“…However, numerous off-label applications are reported in children and in the pediatric urogenital tract, particularly for VUR assessment by contrast-enhanced voiding urosonography (ce-VUS). European questionnaires have demonstrated a good safety profi le (Riccabona 2012 ;Darge et al 2013 ), and dose and procedural recommendations are available for both the intravesical use (i.e., for SonoVue ® 0.5-1 % of actual bladder fi lling volume, for Optison ® 0.5 % of the actual bladder fi lling volume) and the intravenous CEUS (Papdopoulou et al 2012(Papdopoulou et al , 2013. However, recently some more severe reactions to the intravenous application of SonoVue ® have been reported, so justifi ed indications and precautions to mange potential (severe) allergic reactions are mandatory (Riccabona 2013a , b ;Darge et al 2013 ).…”

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

“…22 In the paediatric population, limited studies evaluated the safety profile of ultrasonography contrast agents. [23][24][25][26][27][28] The largest series involved 167 CEUS examinations using SonoVue™ in 137 children, which documented 1 (0.6%) severe allergic reaction. However, no other haemodynamic and oxygenation status changes were documented in this study, and no other subjective complaints were recorded following the CEUS examination.…”

Ultrasound examination in childhood: opportunities and new ways

“…Alkalmazására számos területen lenne szükség gyermekkorban, hiszen drága, sok esetben altatással járó vizsgálatok kiválthatóak általa, például májtranszplantált gyermekeknél jelentősen megkönnyíti az arteria hepatica ábrá-zolását, amely Doppler-vizsgálattal az esetek egy részé-ben nem valósítható meg. Vesetranszplantált betegeknél a perfúzió ábrázolása segítséget jelent a rejectio korai észlelésében [8,9,10,11,12].…”