Spectrum, Applicability and Diagnostic Capacity of Contrast-Enhanced Ultrasound in Pediatric Patients and Young Adults after Intravenous Application – A Retrospective Trial

Abstract

To investigate the spectrum, applicability and diagnostic capacity of intravenous contrast-enhanced ultrasound imaging (CEUS) in a pediatric population. From 08/2005 to 11/2015, n = 40 pediatric patients and young adults from 0 - 26 years (Ø 11.4 ± 7.5) and 3.0 - 85.3 kg (Ø 40.8 ± 25.6) with n = 55 investigations received n = 79 IV applications of ultrasound contrast agent (UCA). UCA dose and side effects were documented. Scanned organs were the liver (n = 42), spleen (n = 9), kidney (n = 3), and testis (n = 1). Histology, surgery or reference imaging was compared to CEUS and clinical follow-up. The UCA dose < 20 kg was 0.4 ± 0.3 ml, (0.05 ± 0.02 ml/kg) and > 20 kg was 1.0 ± 0.4 ml (p< 0.0001) (0.02 ± 0.01 ml/kg, p< 0.0001). Adverse effects occurred in 2/79 applications (2.5 %). Agreement CEUS/gold standard resulted in 32/34 investigations. For liver diagnostics (gold standard: MRI, CT, histology, serology), n = 11 malignant and n = 15 benign focal liver lesions were included. The specificity was 100 % (95 % CI: 0.77 - 1.00), the sensitivity was 82 % (95 % CI: 0.48 - 0.98), the positive predictive value was 100 % (95 % CI: 0.69 - 1.00) and the negative predictive value was 88 % (95 % CI: 0.62 - 0.98, p< 0.0001). In n = 2 reference imaging misdiagnosed and CEUS was in accordance with clinical follow-up. All splenic/renal lesions were diagnosed correctly. In n = 1 an insufficient testicular perfusion was ruled out. The observation time was 30.4 ± 30.5 months. CEUS is a well-tolerated and diagnostically equivalent modality in pediatric care, providing fundamental advantages compared to currently approved imaging modalities for these age groups.

The Safety and Effectiveness of Intravenous Contrast-Enhanced Sonography in Chinese Children—A Single Center and Prospective Study in China

“…In early period, it was suggested that 0.1 ml should be added for every additional year or additional kilogram; and the dose of 2.4 kg was suitable for the subject with a weight over 24 kg in Europe (Stenzel, 2013). There were studies with a fixed dose of 0.1, 0.5, 1.2, 2.4, and 4.8 ml reported (Bonini et al, 2007; Piskunowicz et al, 2012; Jacob et al, 2013; Knieling et al, 2016). In the recent guideline in USA, the recommended dose was 0.03 ml/kg and the maximal dose was 2.4 ml in children (Lumason prescribing information website).…”

Potential causes of insufficient bladder contrast opacification and premature microbubble destruction during contrast‐enhanced voiding urosonography in children

“…The size of the urine catheter was shown to be a statistically insignificant parameter regarding microbubble destruction. The diameter of the 6 F catheter is comparable to that of a 13‐14 gauge needle, which is considered to be risk‐free for contrast breakage . However, in combination with other factors, the catheter diameter may contribute to the premature destruction of microbubbles.…”

“…The diameter of the 6 F catheter is comparable to that of a 13-14 gauge needle, which is considered to be risk-free for contrast breakage. 14,15 However, in combination with other factors, the catheter diameter may contribute to the premature destruction of microbubbles. It is also important to empty the bladder before the contrast infusion; the inflow of the contrast infusion into an insufficiently emptied bladder might contribute to higher bladder pressure at an early point during the course of the examination.…”

Contrast-enhanced ultrasound of benign and malignant liver lesions in children

“…Numerous CEUS studies conducted in adults and a growing number of CEUS studies in children have demonstrated a high safety profile for the intravenous use of UCAs [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. In 2006, the largest prospective multicenter CEUS study, comprising 231,888 adults, reported an incidence of 0.13% for all adverse reactions and 0.01% for serious adverse reactions with UCA administration [22].…”