Contrast-enhanced US Assessment of Focal Liver Lesions in Children

Abstract

Ultrasonography (US) is often the first line of imaging for the examination of children suspected of having liver lesions. However, gray-scale US with color Doppler imaging has limitations. The use of US contrast agents has recently been approved by the U.S. Food and Drug Administration (FDA). Compared with other imaging modalities, contrast material-enhanced US (CEUS) enables the assessment of contrast enhancement patterns with a higher temporal resolution and is therefore becoming a valuable alternative imaging technique. CEUS is advantageous owing to its high safety profile; lower cost, compared with the costs of conventional contrast-enhanced computed tomographic and magnetic resonance imaging examinations; reliability; and reproducibility. Furthermore, US examinations obviate the use of sedation, ionizing radiation, and iodinated or gadolinium-based contrast agents. All of these are desirable attributes for an imaging examination for children, the most vulnerable of patients. Focal liver lesions in children are commonly discovered incidentally, and this can pose a dilemma in terms of diagnosis and management. Owing to the FDA's recent approval of the use of a specific US contrast agent for evaluation of focal liver lesions in pediatric patients, CEUS can now be used as a problem-solving tool that complements conventional imaging examinations and aids in the follow-up of lesions. The temporal resolution with CEUS enables US images to readily depict the real-time internal vascularity of a lesion. The characterization of a lesion during different phases of enhancement improves diagnostic confidence and treatment. In this article, the authors review the composition, physiologic properties, and safety profile of CEUS; describe the technique for performing CEUS; and highlight the utility of this examination in the assessment of common focal liver lesions in children. Online supplemental material is available for this article. RSNA, 2017.

Congenital Limb Overgrowth Syndromes Associated with Vascular Anomalies

“…However, with the recent U.S. Food and Drug Administration approval for use of US contrast agents, this modality is gaining acceptance. Currently approved indications for US in children include the evaluation of focal liver lesions, including hemangiomas (7).…”

“…Finally, contrast-enhanced T1-weighted spinecho and/or gradient-echo MR images yield additional diagnostic information, as each of the various vascular malformations has unique contrast enhancement patterns. The specific imaging characteristics of simple low-and high-flow vascular malformations are summarized in Tables 1 and 2 (1)(2)(3)(4)(6)(7)(8)(9).…”

Imaging of non-neuronopathic Gaucher disease: recent advances in quantitative imaging and comprehensive assessment of disease involvement

“…Therefore, screening evaluation for development of suspicious liver lesions is warranted in Gaucher disease. Identification of more suspicious (e.g., hypoechoic, large, irregular, hypervascular) lesions may warrant further investigation with dedicated liver protocol CT, hepatocyte-specific contrast-enhanced MRI, or contrast-enhanced US, which may offer a viable alternative especially for children [54].…”

Contrast-enhanced ultrasound (CEUS) in abdominal intervention

“…Pediatric CEUS-guided intervention represents a complementary technique for intervention guided by grayscale and color Doppler US. Lumason (Bracco Diagnostics; Monroe Township, NJ) has received regulatory approval for pediatric hepatic use for assessment of pediatric focal liver lesions in the United States [ 10 , 77 ]. Pediatric CEUS has also been extensively in an “off-label” manner [ 78 ] for further indications [ 79 ] with promising results, such as in abdominal trauma [ 75 ] and in established endocavitary use in voiding urosonography [ 21 ].…”