Applications of contrast-enhanced ultrasound in the pediatric abdomen

Abstract

Contrast-enhanced ultrasound (CEUS) is a radiation-free, safe, and in specific clinical settings, highly sensitive imaging modality. Over the recent decades, there is cumulating experience and a large volume of published safety and efficacy data on pediatric CEUS applications. Many of these applications have been directly translated from adults, while others are unique to the pediatric population. The most frequently reported intravenous abdominal applications of CEUS in children are the characterization of focal liver lesions, monitoring of solid abdominal tumor response to treatment, and the evaluation of intra-abdominal parenchymal injuries in selected cases of blunt abdominal trauma. The intravesical CEUS application, namely contrast-enhanced voiding urosonography (ceVUS), is a well-established, pediatric-specific imaging technique entailing the intravesical administration of ultrasound contrast agents for detection and grading of vesicoureteral reflux. In Europe, all pediatric CEUS applications remain off-label. In 2016, the United States Food and Drug Administration (FDA) approved the most commonly used worldwide second-generation ultrasound contrast SonoVue®/Lumason® for pediatric liver and intravesical applications, giving new impetus to pediatric CEUS worldwide.

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

“…Although the second-generation US contrast agents like SonoVue (Bracco, Milan, Italy) are approved for pediatric use to diagnose liver lesions in the United States, off-label use in Europe needs careful consideration. Low frequency of adverse effects is reported but the fact that many Fontan patients have serious cardiac dysfunction and venovenous shunting via collaterals could be a contraindication for use [ 61 , 62 ].…”

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

“…Pediatricians order these drugs because they are important tools in diagnosing and treating many diseases and symptoms and have proven their place in the care of pediatric patients through gained experience and careful clinical evaluation. Support for the use of CEUS in both adults and in children, in a multitude of settings can also be found in various reports . When considering the alternative imaging options as CT or MRI, CEUS proves to be as safe or safer …”

Contrast-enhanced ultrasound liver reporting and data system for hepatocellular carcinoma diagnosis

“…The microbubble contrast agent for CEUS is safe in patients with severe renal impairment, unlike those used in CT or MRI [13,14] . CEUS is approved for the pediatric population and is a very safe alternative that does not require sedation or anesthesia [15] . CEUS has some potential limitations that the practitioner must recognize to tailor its use appropriately.…”