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

Abstract

Background and Objective: Intravenous contrast-enhanced ultrasound (CEUS), using the second-generation ultrasound contrast agent SonoVue®, has been widely used in adults. In 2016, it was approved for pediatric applications by the American Food and Drug Administration (FDA). However, it has not been approved by the Chinese Food and Drug Administration (CFDA). The objective of the study was to evaluate the safety and effectiveness of CEUS in children prospectively at a single center in China. Methods: A total of 312 cases of Chinese children were enrolled in clinical trials. Contrast agent was given intravenously with two different doses, including 2.4 ml/time and 0.03 ml/kg. All CEUS was performed for evaluating adverse effect and the diagnostic accuracy compared with the pathology and enhanced CT. Results: All 312 subjects underwent CEUS successfully. The dose of contrast agent for CEUS was 2.4 ml between November 2015 and June 2016, which was modified to 0.03 ml/kg between July 2016 and April 2019, according to the recommendation of the FDA. With the two different doses of the contrast agent, the heart rate, respiration rate, oxygen saturation, and blood pressure of the participants had no statistically significant difference (P > 0.05) before and after administration. The blood pressure had been significantly decreased in participants who received combined anesthetic administration. Following 600 intravenous injections of the CEUS, there were three cases of transient rash and three cases of hypotension (n = 6, 1.92%). The six recovered quickly after receiving intravenous methylprednisolone and epinephrine. Most of the studies were performed for evaluating renal microcirculation and assisting renal biopsy (192/312 [61.5%]), which together had a 98.9% effectiveness in the identification of pathology in the specimens. Some studies were conducted to identify a mass in the liver, retroperitoneum, abdominal cavity, kidneys, testicles, thyroid, and so on (99/312 [31.4%]), which had a 97.6% accuracy. The other studies were conducted to identify trauma, vascular malformation, infection, hemorrhage, and so on (21/312 [6.73%]), which had a similar accuracy to enhanced CT. Conclusion: The adverse effects of CEUS in children are similar to that in adults. The results indicate that it is safe to use SonoVue® for CEUS in pediatric patients.

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB): An Update on the Pediatric CEUS Registry on Behalf of the “EFSUMB Pediatric CEUS Registry Working Group”

“…The EFSUMB guidelines and position papers on CEUS have reviewed all available evidence and indicated that CEUS is a safe and effective examination in adults [67][68][69]. The series of Mao et al [66], specifically investigating pediatric patients, reports an adverse reaction rate of 6/312 (1.92 %), compared with a reaction rate of 0.9 % in the current study.…”

“…The safety of CEUS has been well documented in adult patients [61,62], and there have been some reports of the safety in children, assessing smaller numbers, with a similar safety profile as that seen in adults [53,[63][64][65][66]. The EFSUMB guidelines and position papers on CEUS have reviewed all available evidence and indicated that CEUS is a safe and effective examination in adults [67][68][69].…”

Contrast-Enhanced Ultrasound for the Characterization of Infantile Hepatic Hemangioma in Premature Neonate

“…The safety profile of UCA is high with very low incidence of side effects [ 2 , 9 ]. The frequency of adverse events associated with the intravenous use of UCA is lower than the one associated with the use of iodinated contrast material at CT and similar to the one associated with the use of gadolinium-based contrast agents [ 2 , 10 ]. However, the long-term effects related to gadolinium-based contrast material deposition in brain tissue are unknown, particularly in small immature babies.…”

Contrast-Enhanced Ultrasound in Children: Implementation and Key Diagnostic Applications

“…In a retrospective review of 173 children, no adverse events were encountered [13]. In a prospective study of 600 injections in 312 children, only 3 mild reactions occurred [11].…”

“…UCA are safe in adults and children [6][7][8][9][10][11][12][13], although safety of UCA in pregnancy is unknown. At our institution, post-pubertal girls undergo screening for possible pregnancy prior to CEUS, similar to before other imaging.…”