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Ultrasound Int Open 2017; 03(01): E2-E7
DOI: 10.1055/s-0042-124502
Review
© Georg Thieme Verlag KG Stuttgart · New York

Clinical Applications of Contrast-Enhanced Ultrasound in the Pediatric Work-Up of Focal Liver Lesions and Blunt Abdominal Trauma: A Systematic Review

Nicolaj Grønbæk Laugesen
1   Neurological, Herlev Hospital, Herlev, Denmark
,
Christian Pallson Nolsoe
2   Ultrasound Section, Department of Gastroenterology, Department of Surgery, Herlev Hospital, Herlev, Denmark
,
Jacob Rosenberg
3   Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 20. Juni 2016
revised 05. Dezember 2016

accepted 11. Dezember 2016

Publikationsdatum:
27. Februar 2017 (online)

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Abstract

In pediatrics ultrasound has long been viewed more favorably than imaging that exposes patients to radiation and iodinated contrast or requires sedation. It is child-friendly and diagnostic capabilities have been improved with the advent of contrast-enhanced ultrasound (CEUS). The application of CEUS is indeed promising. However, no ultrasound contrast agent manufactured today is registered for pediatric use in Europe. The contrast agent SonoVue® has recently been approved by the FDA under the name of Lumason® to be used in hepatic investigations in adults and children. This article reviews the literature with respect to 2 specific applications of CEUS in children: 1) identification of parenchymal injuries following blunt abdominal trauma, and 2) classification of focal liver lesions. Applications were chosen through the CEUS guidelines published by the European Federation of Societies for Ultrasound in Medicine and Biology and World Federation for Ultrasound in Medicine and Biology. Literature was obtained by searching Medline and Pubmed Central (using Pubmed), Scopus database and Embase. CEUS proved to be an effective investigation in the hemodynamically stable child for identifying parenchymal injuries and for the characterization of focal liver lesions. CEUS showed comparable performance to CT and MRI with a specificity of 98% for identifying benign lesions and a negative predictive value of 100%. For the applications reviewed here, CEUS holds promising perspectives and can help reduce radiation exposure and use of iodinated contrast agents in pediatrics, thereby potentially reducing complications in routine imaging.

Key words

paediatrics - ultrasound - contrast-enhanced ultrasound - contrast agents - microbubbles
 

  • References

  • 1 Bauer A, Hauff P, Lazenby J, von Behren P, Zomack M, Reinhardt M et al. Wideband harmonic imaging: a novel contrast ultrasound imaging technique. Eur Radiol 1999; 9 (Suppl. 03) S364-S367
    CrossrefPubMedSuche in Google Scholar
  • 2 Schrope BA, Newhouse VL. Second harmonic ultrasonic blood perfusion measurement. Ultrasound Med Biol 1993; 19: 567-579
    CrossrefPubMedSuche in Google Scholar
  • 3 Piscaglia F, Nolsoe C, Dietrich CF, Cosgrove DO, Gilja OH, Bachmann Nielsen M et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 2012; 33:: 33-59
    Thieme ConnectPubMedSuche in Google Scholar
  • 4 Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsoe CP et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013; 34: 11-29
    Thieme ConnectPubMedSuche in Google Scholar
  • 5 Jakobsen JA, Oyen R, Thomsen HS, Morcos SK. Safety of ultrasound contrast agents. Eur Radiol 2005; 15: 941-945
    CrossrefPubMedSuche in Google Scholar
  • 6 Darge K. Voiding urosonography with US contrast agent for the diagnosis of vesicoureteric reflux in children: an update. Pediatric radiology 2010; 40: 956-962
    CrossrefPubMedSuche in Google Scholar
  • 7 Seitz K, Strobel D. A Milestone: Approval of CEUS for diagnostic liver imaging in adults and children in the USA. Ultraschall Med 2016; 37: 229-232
    Thieme ConnectPubMedSuche in Google Scholar
  • 8 Bracco Prescribing information of Lumason 2016 [cited 2016 10/11]. Available from: http://imaging.bracco.com/sites/braccoimaging.com/files/technica_sheet_pdf/us-en-2016-08-26-pi-Lumason_1.pdf
    PubMed
  • 9 Barr RG. Off-label use of ultrasound contrast agents for abdominal imaging in the United States. J Ultrasound Med 2013; 32: 7-12
    CrossrefPubMedSuche in Google Scholar
  • 10 GMC . General Medical Council of the United Kingdom: Good practice in prescribing and managing medicines and devices. http://www.gmc-uk.org/2016 [updated 02/25/13; cited 2016 09/27]. Available from: http://www.gmc-uk.org/guidance/ethical_guidance/14327.asp
    PubMed
  • 11 Knopf H, Wolf IK, Sarganas G, Zhuang W, Rascher W, Neubert A. Off-label medicine use in children and adolescents: results of a population-based study in Germany. BMC public health 2013; 13: 631
    CrossrefPubMedSuche in Google Scholar
  • 12 Bazzano AT, Mangione-Smith R, Schonlau M, Suttorp MJ, Brook RH. Off-label prescribing to children in the United States outpatient setting. Academic pediatrics 2009; 9: 81-88
    CrossrefPubMedSuche in Google Scholar
  • 13 EMA . Report on the survey of all paediatric uses of medicinal products in Europe. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000096.jsp EMA; 2010 [cited 2015 1st of November]. Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000096.jsp
    PubMed
  • 14 Piscaglia F, Bolondi L. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 2006; 32: 1369-1375
    CrossrefPubMedSuche in Google Scholar
  • 15 Piskunowicz M, Kosiak W, Batko T, Piankowski A, Polczynska K, Adamkiewicz-Drozynska E. Safety of intravenous application of second-generation ultrasound contrast agent in children: prospective analysis. Ultrasound Med Biol 2015; 41: 1095-1099
    CrossrefPubMedSuche in Google Scholar
  • 16 Riccabona M. Application of a second-generation US contrast agent in infants and children – a European questionnaire-based survey. Pediatric radiology 2012; 42: 1471-1480
    CrossrefPubMedSuche in Google Scholar
  • 17 Coleman JL, Navid F, Furman WL, McCarville MB. Safety of ultrasound contrast agents in the pediatric oncologic population: a single-institution experience. AJR Am J Roentgenol 2014; 202: 966-970
    CrossrefPubMedSuche in Google Scholar
  • 18 Valentino M, Serra C, Pavlica P, Labate AM, Lima M, Baroncini S et al. Blunt abdominal trauma: diagnostic performance of contrast-enhanced US in children – initial experience. Radiology 2008; 246: 903-909
    CrossrefPubMedSuche in Google Scholar
  • 19 Menichini G, Sessa B, Trinci M, Galluzzo M, Miele V. Accuracy of contrast-enhanced ultrasound (CEUS) in the identification and characterization of traumatic solid organ lesions in children: a retrospective comparison with baseline US and CE-MDCT. Radiol Med 2015; 120: 989-1001
    CrossrefPubMedSuche in Google Scholar
  • 20 Jacob J, Deganello A, Sellars ME, Hadzic N, Sidhu PS. Contrast enhanced ultrasound (CEUS) characterization of grey-scale sonographic indeterminate focal liver lesions in pediatric practice. Ultraschall Med 2013; 34: 529-540
    Thieme ConnectPubMedSuche in Google Scholar
  • 21 Yusuf GT, Sellars ME, Huang DY, Deganello A, Sidhu PS. Cortical necrosis secondary to trauma in a child: contrast-enhanced ultrasound comparable to magnetic resonance imaging. Pediatric radiology 2014; 44: 484-487
    CrossrefPubMedSuche in Google Scholar
  • 22 Wetli SC, Gralla ES, Schibli S, Stranzinger E. Hepatocellular carcinoma and regenerating nodule in a 3-year-old child with Alagille syndrome. Pediatric radiology 2010; 40: 1696-1698
    CrossrefPubMedSuche in Google Scholar
  • 23 Benya EC, Lim-Dunham JE, Landrum O, Statter M. Abdominal sonography in examination of children with blunt abdominal trauma. AJR Am J Roentgenol 2000; 174: 1613-1616
    CrossrefPubMedSuche in Google Scholar
  • 24 Taylor GA, Sivit CJ. Posttraumatic peritoneal fluid: is it a reliable indicator of intraabdominal injury in children?. J Pediatr Surg 1995; 30: 1644-1648
    CrossrefPubMedSuche in Google Scholar
  • 25 Emery KH, McAneney CM, Racadio JM, Johnson ND, Evora DK, Garcia VF. Absent peritoneal fluid on screening trauma ultrasonography in children: a prospective comparison with computed tomography. J Pediatr Surg 2001; 36: 565-569
    CrossrefPubMedSuche in Google Scholar
  • 26 Lee BC, Ormsby EL, McGahan JP, Melendres GM, Richards JR. The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy. AJR Am J Roentgenol 2007; 188: 415-421
    CrossrefPubMedSuche in Google Scholar
  • 27 Valentino M, De Luca C, Galloni SS, Branchini M, Modolon C, Pavlica P et al. Contrast-enhanced US evaluation in patients with blunt abdominal trauma(). J Ultrasound 2010; 13: 22-27
    CrossrefPubMedSuche in Google Scholar
  • 28 Catalano O, Aiani L, Barozzi L, Bokor D, De Marchi A, Faletti C et al. CEUS in abdominal trauma: multi-center study. Abdominal imaging 2009; 34: 225-234
    CrossrefPubMedSuche in Google Scholar
  • 29 Valentino M, Ansaloni L, Catena F, Pavlica P, Pinna AD, Barozzi L. Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Radiol Med 2009; 114: 1080-1093
    CrossrefPubMedSuche in Google Scholar
  • 30 Valentino M, Serra C, Zironi G, De Luca C, Pavlica P, Barozzi L. Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. AJR Am J Roentgenol 2006; 186: 1361-1367
    CrossrefPubMedSuche in Google Scholar
  • 31 Pinto F, Valentino M, Romanini L, Basilico R, Miele V. The role of CEUS in the assessment of haemodynamically stable patients with blunt abdominal trauma. Radiol Med 2015; 120: 3-11
    CrossrefPubMedSuche in Google Scholar
  • 32 Meyers RL. Tumors of the liver in children. Surgical oncology 2007; 16: 195-203
    CrossrefPubMedSuche in Google Scholar
  • 33 Chiorean L, Cui XW, Tannapfel A, Franke D, Stenzel M, Kosiak W et al. Benign liver tumors in pediatric patients – Review with emphasis on imaging features. World J Gastroenterol 2015; 21: 8541-8561
    CrossrefPubMedSuche in Google Scholar
  • 34 Harkanyi Z. Potential applications of contrast-enhanced ultrasound in pediatric patients. Ultrasound Clinics 8: 403-422
    PubMed
  • 35 Strobel D, Seitz K, Blank W, Schuler A, Dietrich C, von Herbay A et al. Contrast-enhanced ultrasound for the characterization of focal liver lesions – diagnostic accuracy in clinical practice (DEGUM multicenter trial). Ultraschall Med 2008; 29 (05) 499-505
    Thieme ConnectPubMedSuche in Google Scholar
  • 36 Romanini L, Passamonti M, Aiani L, Cabassa P, Raieli G, Montermini I et al. Economic assessment of contrast-enhanced ultrasonography for evaluation of focal liver lesions: a multicentre Italian experience. Eur Radiol 2007; 17 (Suppl. 06) F99-F106
    CrossrefPubMedSuche in Google Scholar
  • 37 Westwood M, Joore M, Grutters J, Redekop K, Armstrong N, Lee K et al. Contrast-enhanced ultrasound using SonoVue(R) (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis. Health technology assessment (Winchester, England) 2013; 17: 1-243
    PubMedSuche in Google Scholar
  • 38 Nolsoe CP, Lorentzen T. International guidelines for contrast-enhanced ultrasonography: ultrasound imaging in the new millennium. Ultrasonography (Seoul, Korea) 2016; 35: 89-103
    CrossrefPubMedSuche in Google Scholar
  • 39 Efsumb EFSUMB Pediatric Registry [cited 2016 10/8/2016]. Available from: http://www.efsumb.org/education/scientific-corner01.asp
    PubMed