Use of CEUS for Imaging Evaluation of Pediatric Peritonsillar Abscess

Abstract

Purpose Peritonsillar abscess can be diagnosed by B-mode ultrasound and cross-sectional imaging. The latter (with MRI being the modality of first choice in children) is associated with higher effort and risk for pediatric patients due to the administration of X-rays and/or the need of sedation. The purpose of this study is to evaluate whether the introduction of CEUS into the diagnostic algorithm for suspected pediatric peritonsillar abscess is suitable and advantageous.

Materials and methods Single-institution retrospective review of data of pediatric patients who were presented to the department of pediatric radiology for sonographic evaluation under the suspicion of peritonsillar abscess. Diagnostic performance of CEUS was evaluated by using surgical exploration or clinical follow-up as the reference standard.

Results 284 children included in the study underwent B-mode ultrasound. Mean age of all patients was 6,23 years. Peritonsillar abscess was the diagnosis in 42 patients. Diagnosis of peritonsillar abscess was made by B-mode ultrasound alone in 13 of 42 patients (31 %). In 17 of 42 patients (40 %), diagnosis was made by a combination of B-mode ultrasound and CEUS. Sensitivity rose from 37 % to 86 % in cases where B-mode ultrasound remained unclear and CEUS was used.

Conclusion Contrast-enhanced ultrasound (CEUS) is suitable and efficient for the diagnosis of peritonsillar abscess in pediatric patients. It increases the sensitivity for the diagnosis of peritonsillar abscess and thereby reduces the need of additional cross-sectional imaging for the pediatric patients.

Zusammenfassung

Ziel Peritonsillarabszesse können mittels B-Bild-Ultraschall und Schnittbildgebung diagnostiziert werden (mit MRT als Modalität der ersten Wahl). Schnittbildgebung ist aufwändiger und birgt mit der Anwendung von Röntgenstrahlen bzw. der Notwendigkeit einer Sedierung für pädiatrische Patienten Risiken. Mit der vorliegenden Arbeit soll evaluiert werden, ob die Einführung von CEUS in den diagnostischen Algorithmus bei Verdacht auf Peritonsillarabszess hierfür geeignet und vorteilhaft ist.

Material und Methode Monozentrische, retrospektive Auswertung von Daten von pädiatrischen Patienten, die in der Kinderradiologie zur Sonografie unter dem Verdacht auf einen Peritonsillarabszess vorgestellt wurden. Die diagnostische Wertigkeit des CEUS wurde unter Verwendung eines Referenzstandards evaluiert.

Ergebnisse In die Studie wurden 284 Kinder (mittleres Alter 6,23 Jahre) eingeschlossen, die mittels B-Bild-Ultraschall untersucht wurden. Ein Peritonsillarabszess wurde in 42 Fällen diagnostiziert. Bei 13 der 42 Patienten (31%) wurde die Diagnose allein mittels B-Bild-Ultraschall gestellt, bei 17 der 42 Patienten (40%) durch eine Kombination aus B-Bild-Ultraschall und CEUS. Die Sensitivität stieg in den Fällen, in denen der B-Bild-Ultraschall ein unklares Ergebnis zeigte und CEUS zum Einsatz kam, von 37% auf 86% an.

Schlussfolgerungen Kontrastmittel-Ultraschall (CEUS) ist für die Diagnostik des Peritonsillarabszesses bei pädiatrischen Patienten geeignet und vorteilhaft. Er erhöht die Sensitivität für die Diagnosestellung des Peritonsillarabszesses und reduziert hierdurch die Notwendigkeit einer Anwendung von Schnittbildgebung bei den pädiatrischen Patienten.

Keywords

CEUS - Pediatrics - Peritonsillar abscess - METHODS & TECHNIQUES - ultrasound

Publication History

Received: 01 October 2021

Accepted after revision: 23 January 2023

Accepted Manuscript online:
23 January 2023

Article published online:
07 March 2023

• References

• 1 Bandarkar AN, Adeyiga AO, Fordham MT. et al. Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. Pediatr Radiol 2016; 46: 1059-1067
• 2 Huang Z, Vintzileos W, Gordish-Dressman H. et al. Pediatric peritonsillar abscess: Outcomes and cost savings from using transcervical ultrasound. The Laryngoscope 2017; 127: 1924-1929
• 3 Froehlich MH, Huang Z, Reilly BK. Utilization of ultrasound for diagnostic evaluation and management of peritonsillar abscesses. Curr Opin Otolaryngol Head Neck Surg 2017; 25: 163-168
• 4 Halim A, Shih Y, Dodds SD. The utility of ultrasound for diagnosing purulent infections of the upper extremity. Hand (N Y) 2015; 10: 701-706
• 5 Bansal AG, Oudsema R, Masseaux JA. et al. US of Pediatric Superficial Masses of the Head and Neck. Radiographics 2018; 38: 1239-1263
• 6 Lim AKP, Satchithananda K, Dick EA. et al. Microflow imaging: New Doppler technology to detect low-grade inflammation in patients with arthritis. Eur Radiol 2018; 28: 1046-1053
• 7 Windfuhr JP, Toepfner N, Steffen G. et al. Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. Eur Arch Otorhinolaryngol 2016; 273: 973-987
• 8 Lee CH, Hsu WC, Ko JY. et al. Trends in the management of peritonsillar abscess in children: A nationwide population-based study in Taiwan. Int J Pediatr Otorhinolaryngol 2019; 125: 32-37
• 9 Printz C. Pediatric computed tomography scans. Weighing the risks and benefits: A new study suggests that computed tomography-related radiation may increase the risk of brain tumors, but the conversation, physicians say, is complex-and far from settled. Cancer 2019; 125: 171-173
• 10 Arlachov Y, Ganatra RH. Sedation/anaesthesia in paediatric radiology. Br J Radiol 2012; 85: e1018-1031
• 11 Callahan MJ, MacDougall RD, Bixby SD. et al. Ionizing radiation from computed tomography versus anesthesia for magnetic resonance imaging in infants and children: patient safety considerations. Pediatr Radiol 2018; 48: 21-30
• 12 Mulvihill DJ, Jhawar S, Kostis JB. et al. Diagnostic Medical Imaging in Pediatric Patients and Subsequent Cancer Risk. Acad Radiol 2017; 24: 1456-1462
• 13 Heikkinen J, Nurminen J, Velhonoja J. et al. MRI Findings in Acute Tonsillar Infections. AJNR. Am J Neuroradiol 2022; 43: 286-291
• 14 Nurminen J, Velhonoja J, Heikkinen J. et al. Emergency neck MRI: feasibility and diagnostic accuracy in cases of neck infection. Acta Radiol 2021; 62: 735-742
• 15 Nurminen J, Heikkinen J, Happonen T. et al. Magnetic resonance imaging findings in pediatric neck infections-a comparison with adult patients. Pediatr Radiol 2022; 52: 1158-1166
• 16 Miele V, Piccolo CL, Trinci M. et al. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med 2016; 121: 409-430
• 17 Trinci M, Piccolo CL, Ferrari R. et al. Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma. J Ultrasound 2019; 22: 27-40
• 18 Sidhu PS, Cantisani V, Deganello A. et al. Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement. Ultraschall in Med 2017; 38: 33-43
• 19 Chiorean L, Cui X W, Tannapfel A. et al. Benign liver tumors in pediatric patients – Review with emphasis on imaging features. World J Gastroenterol 2015; 21: 8541-8561
• 20 Darge K, Papadopoulou F, Ntoulia A. et al. 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). Pediatr Radiol 2013; 43: 1063-1073
• 21 Čizmarević U, Hanžič N, Žerdin M. The Use of Contrast-enhanced Ultrasound in Pediatrics: A Case Series. Cureus 2019; 11: e6215
• 22 Baker KA, Stuart J, Sykes KJ. et al. Use of computed tomography in the emergency department for the diagnosis of pediatric peritonsillar abscess. Pediatr Emerg Care 2012; 28: 962-965
• 23 Grant MC, Guarisco JL. Association Between Computed Tomographic Scan and Timing and Treatment of Peritonsillar Abscess in Children. JAMA Otolaryngol Head Neck Surg 2016; 142: 1051-1055
• 24 Capps EF, Kinsella JJ, Gupta M. et al. Emergency imaging assessment of acute, nontraumatic conditions of the head and neck. Radiographics 2010; 30: 1335-1352
• 25 Rawlins KW, Allen DZ, Onwuka AJ. et al. Computed tomography use patterns for pediatric patients with peritonsillar abscess. Int J Pediatr Otorhinolaryngol 2019; 123: 22-25
• 26 Yusuf GT, Sellars ME, Deganello A. et al. Retrospective Analysis of the Safety and Cost Implications of Pediatric Contrast-Enhanced Ultrasound at a Single Center. AJR Am J Roentgenol 2017; 208: 446-452