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Dong Y, Cekuolis A, Schreiber-Dietrich D, Augustiniene R, Schwarz S, Möller K, Nourkami-Tutdibi N, Chen S, Cao JY, Huang YL, Wang Y, Taut H, Grevelding L, Dietrich CF. Review on Pediatric Malignant Focal Liver Lesions with Imaging Evaluation: Part I. Diagnostics (Basel) 2023; 13:3568. [PMID: 38066809 PMCID: PMC10706220 DOI: 10.3390/diagnostics13233568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Malignant focal liver lesions (FLLs) are commonly reported in adults but rarely seen in the pediatric population. Due to the rarity, the understanding of these diseases is still very limited. In children, most malignant FLLs are congenital. It is very important to choose appropriate imaging examination concerning various factors. This paper will outline common pediatric malignant FLLs, including hepatoblastoma, hepatocellular carcinoma, and cholangiocarcinoma and discuss them against the background of the latest knowledge on comparable/similar tumors in adults. Medical imaging features are of vital importance for the non-invasive diagnosis and follow-up of treatment of FLLs in pediatric patients. The use of CEUS in pediatric patients for characterizing those FLLs that remain indeterminate on conventional B mode ultrasounds may be an effective option in the future and has great potential to be integrated into imaging algorithms without the risk of exposure to ionizing radiation.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Andrius Cekuolis
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania; (A.C.); (R.A.)
| | | | - Rasa Augustiniene
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania; (A.C.); (R.A.)
| | - Simone Schwarz
- Department of Neonatology and Pediatric Intensive Care Medicine, Sana Kliniken Duisburg GmbH, 47055 Duisburg, Germany;
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany;
| | - Nasenien Nourkami-Tutdibi
- Saarland University Medical Center, Hospital of General Pediatrics and Neonatology, 66421 Homburg, Germany;
| | - Sheng Chen
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Jia-Ying Cao
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Yun-Lin Huang
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Ying Wang
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Heike Taut
- Children’s Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Lara Grevelding
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University, 60323 Frankfurt, Germany
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland
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Paltiel HJ, Barnewolt CE, Chow JS, Bauer SB, Diamond DA, Stamoulis C. Accuracy of contrast-enhanced voiding urosonography using Optison™ for diagnosis of vesicoureteral reflux in children. J Pediatr Urol 2023; 19:135.e1-135.e8. [PMID: 36333198 DOI: 10.1016/j.jpurol.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is limited quality of evidence regarding the accuracy of contrast-enhanced voiding urosonography (ceVUS) for diagnosis of vesicoureteral reflux (VUR) compared to fluoroscopic voiding cystourethrography (VCUG), and minimal data on the use of the ultrasound contrast agent Optison™ for this purpose. OBJECTIVE To compare the accuracy of ceVUS using Optison™ to VCUG, and to assess inter-rater agreement regarding presence and grading of VUR. STUDY DESIGN In this retrospective investigation, all sequential ceVUS with Optison™ and VCUG studies performed in children between 2014 and 2017 were reviewed. Two raters independently graded all ceVUS studies using a 5-point scale. CeVUS sensitivity and specificity were estimated separately for each rater using the VCUG report as the ground truth for presence and degree of VUR. Logistic and ordinary linear regression models assessed rater-report agreement and inter-rater agreement for each kidney, Optison™ dose, and referral diagnosis. RESULTS 97 children (51 females) with 101 paired studies were included. Sensitivity and specificity of ceVUS for VUR detection were identical for both raters: right kidney 75%/90.9%; left kidney 85.7%/78.9% (Figure). There was no statistically significant difference in disagreement between raters and the VCUG report for the right or left kidney. Inter-rater agreement on ceVUS grading was 90% and 88% for right and left kidneys, respectively. There was a significant negative association between fetal hydronephrosis vs urinary tract infection and disagreement between Rater 2 and the VCUG report for the left kidney. There were no other significant associations with respect to either kidney, Optison™ dose, or referral diagnosis. DISCUSSION Our study showed that detection of VUR with ceVUS and Optison™ is comparable to fluoroscopic VCUG. Based on the VCUG reports, the incidence of VUR in our patient population was substantially lower than in the meta-analysis of Chua et al. and in the study of Kim et al. The explanation for the large discrepancy in VUR incidence may reflect differences in the patient populations, and in our reporting of VUR with respect to kidney number rather than to pelviureteral units. Study limitations include its retrospective nature and potential bias in terms of patient selection. Since VUR is an intermittent phenomenon, sequential rather than simultaneous performance of the ceVUS and fluoroscopic studies might have influenced VUR detection. CONCLUSION A blinded comparison of ceVUS performed with Optison™ to fluoroscopic VCUG showed moderate-good sensitivity and specificity for diagnosis of VUR.
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Affiliation(s)
- Harriet J Paltiel
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Stuart B Bauer
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Urology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14620, USA.
| | - Catherine Stamoulis
- Department of Adolescent Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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3
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Preoperative risk stratification in women with endometrial cancer: A comparison of contrast-enhanced MR imaging and diffusion-weighted MR imaging. Eur J Radiol 2022; 150:110276. [PMID: 35339860 DOI: 10.1016/j.ejrad.2022.110276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/24/2022] [Accepted: 03/20/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare CE MRI and DWI in the risk stratification of women with endometrial cancer for lymph node metastasis. METHOD Two readers independently assessed the degree of myometrial invasion on two separate occasions in a retrospective cohort of 84 women with endometrial cancers: once with CE MRI and standard anatomic sequences and another time with DWI and standard anatomic sequences. Participants were stratified according to their risk of lymph node metastasis following the European Society for Medical Oncology guidelines. The rate of lymph node metastasis was compared between the risk stratification groups obtained using CE MRI or DWI by generalized estimating equations. RESULTS In the low-risk group, the rate of lymph node metastasis was 1.9% (1/53) when using CE MRI and 1.9% (1/54) when using DWI for reader 1, and 3.8% (2/52) when using CE MRI and 1.9% (1/52) when using DWI for reader 2. The rate of lymph node metastasis in the high-risk group was 25.8% (8/31) when using CE MRI and 26.7% (8/30) when using DWI for reader 1, and 21.9% (7/32) when using CE MRI and 25.0% (8/32) when using DWI for reader 2. There was no significant difference between CE MRI and DWI in the rate of lymph node metastasis according to the risk stratification (p > .05 in both low- and high-risk groups for both readers). CONCLUSION DWI might be a comparable alternative to CE MRI in the preoperative risk stratification of women with endometrial cancer for lymph node metastasis.
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Hwang M, Back SJ, Didier RA, Lorenz N, Morgan TA, Poznick L, Steffgen L, Sridharan A. Pediatric contrast-enhanced ultrasound: optimization of techniques and dosing. Pediatr Radiol 2021; 51:2147-2160. [PMID: 32955599 DOI: 10.1007/s00247-020-04812-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/08/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022]
Abstract
When performing contrast-enhanced ultrasound (CEUS), ultrasound (US) scanner settings, examination technique, and contrast agent dose and administration must be optimized to ensure that high-quality, diagnostic and reproducible images are acquired for qualitative and quantitative interpretations. When carrying out CEUS in children, examination settings should be tailored to their body size and specific indications, similar to B-mode US. This review article details the basic background knowledge that is needed to perform CEUS optimally in children, including considerations related to US scanner settings and US contrast agent dose selection and administration techniques.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryne A Didier
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Norbert Lorenz
- Children's Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University, Dresden, Germany
| | - Trudy A Morgan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Laura Poznick
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ludwig Steffgen
- Trainings-Zentrum Ultraschall-Diagnostik LS GmbH, Mainleus, Germany
| | - Anush Sridharan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
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5
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Paltiel HJ, Barth RA, Bruno C, Chen AE, Deganello A, Harkanyi Z, Henry MK, Ključevšek D, Back SJ. Contrast-enhanced ultrasound of blunt abdominal trauma in children. Pediatr Radiol 2021; 51:2253-2269. [PMID: 33978795 DOI: 10.1007/s00247-020-04869-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/26/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022]
Abstract
Trauma is the leading cause of morbidity and mortality in children, and rapid identification of organ injury is essential for successful treatment. Contrast-enhanced ultrasound (CEUS) is an appealing alternative to contrast-enhanced CT in the evaluation of children with blunt abdominal trauma, mainly with respect to the potential reduction of population-level exposure to ionizing radiation. This is particularly important in children, who are more vulnerable to the hazards of ionizing radiation than adults. CEUS is useful in hemodynamically stable children with isolated blunt low- to moderate-energy abdominal trauma to rule out solid organ injuries. It can also be used to further evaluate uncertain contrast-enhanced CT findings, as well as in the follow-up of conservatively managed traumatic injuries. CEUS can be used to detect abnormalities that are not apparent by conventional US, including infarcts, pseudoaneurysms and active bleeding. In this article we present the current experience from the use of CEUS for the evaluation of pediatric blunt abdominal trauma, emphasizing the examination technique and interpretation of major abnormalities associated with injuries in the liver, spleen, kidneys, adrenal glands, pancreas and testes. We also discuss the limitations of the technique and offer a review of the major literature on this topic in children, including an extrapolation of experience from adults.
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Affiliation(s)
- Harriet J Paltiel
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Richard A Barth
- Department of Radiology, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Costanza Bruno
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Aaron E Chen
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - M Katherine Henry
- Safe Place: The Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Ntoulia A, Anupindi SA, Back SJ, Didier RA, Hwang M, Johnson AM, McCarville MB, Papadopoulou F, Piskunowicz M, Sellars ME, Darge K. Contrast-enhanced ultrasound: a comprehensive review of safety in children. Pediatr Radiol 2021; 51:2161-2180. [PMID: 34716453 DOI: 10.1007/s00247-021-05223-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/10/2021] [Accepted: 10/11/2021] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) has been increasingly used in pediatric radiology practice worldwide. For nearly two decades, CEUS applications have been performed with the off-label use of gas-containing second-generation ultrasound contrast agents (UCAs). Since 2016, the United States Food and Drug Administration (FDA) has approved the UCA Lumason for three pediatric indications: the evaluation of focal liver lesions and echocardiography via intravenous administration and the assessment of vesicoureteral reflux via intravesical application (contrast-enhanced voiding urosonography, ceVUS). Prior to the FDA approval of Lumason, numerous studies with the use of second-generation UCAs had been conducted in adults and children. Comprehensive protocols for clinical safety evaluations have demonstrated the highly favorable safety profile of UCA for intravenous, intravesical and other intracavitary uses. The safety data on CEUS continue to accumulate as this imaging modality is increasingly utilized in clinical settings worldwide. As of August 2021, 57 pediatric-only original research studies encompassing a total of 4,518 children with 4,906 intravenous CEUS examinations had been published. As in adults, there were a few adverse events; the majority of these were non-serious, although very rarely serious anaphylactic reactions were reported. In the published pediatric-only intravenous CEUS studies included in our analysis, the overall incidence rate of serious adverse events was 0.22% (10/4,518) of children and 0.20% (10/4,906) of all CEUS examinations. Non-serious adverse events from the intravenous CEUS were observed in 1.20% (54/4,518) of children and 1.10% (54/4,906) of CEUS examinations. During the same time period, 31 studies with the intravesical use of UCA were conducted in 12,362 children. A few non-serious adverse events were encountered (0.31%; 38/12,362), but these were most likely attributable to the bladder catheterization rather than the UCA. Other developing clinical applications of UCA in children, including intracavitary and intralymphatic, are ongoing. To date, no serious adverse events have been reported with these applications. This article reviews the existing pediatric CEUS literature and provides an overview of safety-related information reported from UCA uses in children.
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Affiliation(s)
- Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryne A Didier
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann M Johnson
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Maria E Sellars
- Department of Radiology, King's College Hospital, London, UK
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Dietrich CF, Augustiniene R, Batko T, Cantisani V, Cekuolis A, Deganello A, Dong Y, Franke D, Harkanyi Z, Humphries PD, Jędrzejczyk M, Jüngert J, Kinkel H, Koller O, Kosiak W, Kunze C, Ljutikov A, Madzik J, Mentzel HJ, Piskunowicz M, Rafailidis V, Schreiber-Dietrich D, Sellars ME, Stenzel M, Taut H, Yusuf GT, Sidhu PS. 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". ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:270-277. [PMID: 33690876 DOI: 10.1055/a-1345-3626] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The European Federation of Ultrasound in Medicine and Biology (EFSUMB) created the "EFSUMB Pediatric Registry" (EFSUMB EPR) with the purpose of collecting data regarding the intravenous application of pediatric contrast-enhanced ultrasound (CEUS). The primary aim was to document the current clinical practice and usefulness of the technique and secondarily to assess CEUS safety in children. We issue the preliminary results of this database and examine the overall practice of CEUS in children in Europe.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Germany
- Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
| | - Rasa Augustiniene
- Department of Radiology, Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Tomasz Batko
- Department of Pediatric, Haematology and Oncology, Medical University of Gdansk, Poland
| | - Vito Cantisani
- Radiological, Oncological and Anatomy-Pathological Sciences University Sapienza of Rome, Italy
| | - Andrius Cekuolis
- Department of Radiology, Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Annamaria Deganello
- Department of Radiology, King's College London, King's College Hospital, United Kingdom of Great Britain and Northern Ireland
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Doris Franke
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Paul D Humphries
- Great Ormond Street Hospital for Children and University College London NHS Foundation Trusts
| | - Maciej Jędrzejczyk
- Ultrasound Diagnostic Department, Faculty of Medical Sciences, Medical University of Warsaw, Poland
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Horst Kinkel
- Krankenhaus Düren, Klinik für Gastroenterologie, Hepatologie, Diabetologie und Intensivmedizin, Düren, Germany
| | - Orsolya Koller
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Wojciech Kosiak
- Ultrasound and Biopsy Diagnostics Lab at the Clinic of Pediatrics, Haematology and Oncology, Medical University of Gdansk, Poland
| | - Christian Kunze
- Clinic and Policlinic of Radiology, University Medical Center Halle (Saale), Germany
| | - Anoushka Ljutikov
- Department of Diagnostic Imaging, Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Jaroslaw Madzik
- Institute of Mother and Child, Department of Diagnostic Imaging, Warsaw, Poland
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology. University Hospital Jena, Germany
| | | | - Vasileios Rafailidis
- Department of Radiology, King's College London, King's College Hospital, United Kingdom of Great Britain and Northern Ireland
| | - Dagmar Schreiber-Dietrich
- Localinomed, Bern Switzerland
- Department of Pediatric Medicine, Caritas-Krankenhaus Bad Mergentheim, Germany
| | - Maria E Sellars
- Department of Radiology, King's College London, King's College Hospital, United Kingdom of Great Britain and Northern Ireland
| | - Martin Stenzel
- Kliniken der Stadt Köln gGmbH, Kinderradiologie, Köln, Germany
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Gibran T Yusuf
- Department of Radiology, King's College London, King's College Hospital, United Kingdom of Great Britain and Northern Ireland
| | - Paul S Sidhu
- Department of Radiology, King's College London, King's College Hospital, United Kingdom of Great Britain and Northern Ireland
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8
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Fang C, Anupindi SA, Back SJ, Franke D, Green TG, Harkanyi Z, Jüngert J, Kwon JK, Paltiel HJ, Squires JH, Zefov VN, McCarville MB. Contrast-enhanced ultrasound of benign and malignant liver lesions in children. Pediatr Radiol 2021; 51:2181-2197. [PMID: 33978801 PMCID: PMC8566652 DOI: 10.1007/s00247-021-04976-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) is increasingly being used in children. One of the most common referrals for CEUS performance is characterization of indeterminate focal liver lesions and follow-up of known liver lesions. In this setting, CEUS is performed with intravenous administration of ultrasound contrast agents (UCAs). When injected into a vein, UCA microbubbles remain confined within the vascular network until they dissipate. Therefore, visualization of UCA within the tissues and lesions corresponds to true blood flow. CEUS enables continuous, real-time observation of the enhancement pattern of a focal liver lesion, allowing in most cases for a definite diagnosis and obviating the need for further cross-sectional imaging or other interventional procedures. The recent approval of Lumason (Bracco Diagnostics, Monroe Township, NJ) for pediatric liver CEUS applications has spurred the widespread use of CEUS. In this review article we describe the role of CEUS in pediatric liver applications, focusing on the examination technique and interpretation of main imaging findings of the most commonly encountered benign and malignant focal liver lesions. We also compare the diagnostic performance of CEUS with other imaging modalities for accurate characterization of focal liver lesions.
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Affiliation(s)
- Cheng Fang
- Department of Radiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Sudha A. Anupindi
- Department of Radiology, Perelman School of Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA USA
| | - Susan J. Back
- Department of Radiology, Perelman School of Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA USA
| | - Doris Franke
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | | | - Zoltan Harkanyi
- Department of Radiology, Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Jörg Jüngert
- Department of Pediatrics, Friedrich-Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Jeannie K. Kwon
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Harriet J. Paltiel
- Department of Radiology, Harvard Medical School, Boston Children’s Hospital, Boston, MA USA
| | - Judy H. Squires
- Department of Radiology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Vassil N. Zefov
- Department of Radiology, Dubai Health Authority, Latifa Women and Children Hospital, Dubai, UAE
| | - M. Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA
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9
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Huang DY, Pesapane F, Rafailidis V, Deganello A, Sellars ME, Sidhu PS. The role of multiparametric ultrasound in the diagnosis of paediatric scrotal pathology. Br J Radiol 2020; 93:20200063. [PMID: 32271626 PMCID: PMC10993215 DOI: 10.1259/bjr.20200063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Multiparametric ultrasound (MPUS), combining conventional techniques (greyscale and colour Doppler ultrasound), ultrasound strain elastography, and contrast-enhanced ultrasound (CEUS), has been successfully used in the assessment of adult scrotal pathology. Contrast-enhanced ultrasound can confidently establish testicular tissue vascularity even in the small-volume paediatric testis. Elastography provides further assessment of tissue stiffness, potentially adding useful diagnostic information. In children, ultrasonography is particularly advantageous, being safe, radiation-free and negating the need for sedation or general anaesthesia during the imaging evaluation. In this review article, we aim to familiarise readers with the MPUS scanning protocol used for paediatric scrotal examination and provide an overview of scrotal MPUS features, with particular focus to clinical indications where MPUS may be advantageous over conventional ultrasonography.
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Affiliation(s)
- Dean Y. Huang
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology
IRCCS, Via Giuseppe Ripamonti 435, 20141,
Milan, Italy
| | - Vasileios Rafailidis
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Annamaria Deganello
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Maria E. Sellars
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Paul S Sidhu
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
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10
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Frinking P, Segers T, Luan Y, Tranquart F. Three Decades of Ultrasound Contrast Agents: A Review of the Past, Present and Future Improvements. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:892-908. [PMID: 31941587 DOI: 10.1016/j.ultrasmedbio.2019.12.008] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
Initial reports from the 1960s describing the observations of ultrasound contrast enhancement by tiny gaseous bubbles during echocardiographic examinations prompted the development of the first ultrasound contrast agent in the 1980s. Current commercial contrast agents for echography, such as Definity, Optison, Sonazoid and SonoVue, have proven to be successful in a variety of on- and off-label clinical indications. Whereas contrast-specific technology has seen dramatic progress after the introduction of the first approved agents in the 1990s, successful clinical translation of new developments has been limited during the same period, while understanding of microbubble physical, chemical and biologic behavior has improved substantially. It is expected that for a successful development of future opportunities, such as ultrasound molecular imaging and therapeutic applications using microbubbles, new creative developments in microbubble engineering and production dedicated to further optimizing microbubble performance are required, and that they cannot rely on bubble technology developed more than 3 decades ago.
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Affiliation(s)
- Peter Frinking
- Tide Microfluidics, Capitool 41, Enschede, The Netherlands.
| | - Tim Segers
- Physics of Fluids group, University of Twente, Enschede, The Netherlands
| | - Ying Luan
- R&D Pharmaceutical Diagnostics, General Electric Healthcare, Amersham, UK
| | - François Tranquart
- R&D Pharmaceutical Diagnostics, General Electric Healthcare, Amersham, UK
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11
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Woo S, Moon MH, Cho JY, Kim SH, Kim SY. Diagnostic Performance of MRI for Assessing Parametrial Invasion in Cervical Cancer: A Head-to-Head Comparison between Oblique and True Axial T2-Weighted Images. Korean J Radiol 2019; 20:378-384. [PMID: 30799568 PMCID: PMC6389805 DOI: 10.3348/kjr.2018.0248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/29/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To directly compare the diagnostic performance of true and oblique axial T2-weighted imaging (T2WI) for assessing parametrial invasion (PMI) in cervical cancer. MATERIALS AND METHODS This retrospective study included 71 women with treatment-naive cervical cancer who underwent MRI that included both oblique and true axial T2WI, followed by radical hysterectomy. Two blinded radiologists (Radiologist 1 and Radiologist 2) independently assessed the presence of PMI on both sequences using a 5-point Likert scale. Receiver operating characteristic (ROC) curve analysis was performed, with a subgroup analysis for tumors sized > 2.5 cm and ≤ 2.5 cm in diameter. Inter-reader agreement was assessed with kappa (k) statistics. RESULTS At hysterectomy, 15 patients (21.1%) had PMI. For Radiologist 1, the area under the ROC curve (AUC) was greater for oblique axial than for true axial T2WI {0.941 (95% confidence interval [CI] = 0.858-0.983) vs. 0.917 (95% CI = 0.827-0.969), p = 0.027}. The difference was not significant for Radiologist 2 (0.879 [95% CI = 0.779-0.944] vs. 0.827 [95% CI = 0.719-0.906], p = 0.153). For tumors > 2.5 cm, AUC was greater with oblique than with true axial T2WI (0.906 vs. 0.860, p = 0.046 for Radiologist 1 and 0.839 vs. 0.765, p = 0.086 for Radiologist 2). Agreement between the radiologists was almost perfect for oblique axial T2WI (k = 0.810) and was substantial for true axial T2WI (k = 0.704). CONCLUSION Oblique axial T2WI potentially provides greater diagnostic performance than true axial T2WI for determining PMI, particularly for tumors > 2.5 cm. The inter-reader agreement was greater with oblique axial T2WI.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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12
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Ntoulia A, Anupindi SA, Darge K, Back SJ. Applications of contrast-enhanced ultrasound in the pediatric abdomen. Abdom Radiol (NY) 2018; 43:948-959. [PMID: 28980061 DOI: 10.1007/s00261-017-1315-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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.
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Affiliation(s)
- Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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13
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Ranganath PG, Robbin ML, Back SJ, Grant EG, Fetzer DT. Practical advantages of contrast-enhanced ultrasound in abdominopelvic radiology. Abdom Radiol (NY) 2018; 43:998-1012. [PMID: 29332247 DOI: 10.1007/s00261-017-1442-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) are two of the workhorse modalities of abdominopelvic radiology. However, these modalities are not without patient- and technique-specific limitations that may prevent a timely and accurate diagnosis. Contrast-enhanced ultrasound (CEUS) is an effective, rapid, and cost-effective imaging modality with expanding clinical utility in the United States. In this pictorial essay, we provide a case-based discussion demonstrating the practical advantages of CEUS in evaluating a variety of pathologies in which CT or MRI was precluded or insufficient. Through these advantages, CEUS can serve a complementary role with CT and MRI in comprehensive abdominopelvic radiology.
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14
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Armstrong LB, Mooney DP, Paltiel H, Barnewolt C, Dionigi B, Arbuthnot M, Onwubiko C, Connolly SA, Jarrett DY, Zalieckas JM. Contrast enhanced ultrasound for the evaluation of blunt pediatric abdominal trauma. J Pediatr Surg 2018; 53:548-552. [PMID: 28351519 DOI: 10.1016/j.jpedsurg.2017.03.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/08/2017] [Accepted: 03/12/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Blunt abdominal trauma is a common problem in children. Computed tomography (CT) is the gold standard for imaging in pediatric blunt abdominal trauma, however up to 50% of CTs are normal and CT carries a risk of radiation-induced cancer. Contrast enhanced ultrasound (CEUS) may allow accurate detection of abdominal organ injuries while eliminating exposure to ionizing radiation. METHODS Children aged 7-18years with a CT-diagnosed abdominal solid organ injury underwent grayscale/power Doppler ultrasound (conventional US) and CEUS within 48h of injury. Two blinded radiologists underwent a brief training in CEUS and then interpreted the CEUS images without patient interaction. Conventional US and CEUS images were compared to CT for the presence of injury and, if present, the injury grade. Patients were monitored for contrast-related adverse reactions. RESULTS Twenty one injured organs were identified by CT in eighteen children. Conventional US identified the injuries with a sensitivity of 45.2%, which increased to 85.7% using CEUS. The specificity of conventional US was 96.4% and increased to 98.6% using CEUS. The positive predictive value increased from 79.2% to 94.7% and the negative predictive value from 85.3% to 95.8%. Two patients had injuries that were missed by both radiologists on CEUS. In a 100kg, 17year old female, a grade III liver injury was not seen by either radiologist on CEUS. Her accompanying grade I kidney injury was not seen by one of the radiologist on CEUS. The second patient, a 16year old female, had a grade III splenic injury that was missed by both radiologists on CEUS. She also had an adjacent grade II kidney injury that was seen by both. Injuries, when noted, were graded within 1 grade of CT 33/35 times with CEUS. There were no adverse reactions to the contrast. CONCLUSION CEUS is a promising imaging modality that can detect most abdominal solid organ injuries in children while eliminating exposure to ionizing radiation. A multicenter trial is warranted before widespread use can be recommended. LEVEL OF EVIDENCE Level II; Diagnostic Prospective Study.
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Affiliation(s)
- Lindsey B Armstrong
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
| | - David P Mooney
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA
| | - Harriet Paltiel
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA
| | - Carol Barnewolt
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA
| | - Beatrice Dionigi
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA
| | - Mary Arbuthnot
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA
| | - Chinwendu Onwubiko
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA
| | - Susan A Connolly
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA
| | - Delma Y Jarrett
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA
| | - Jill M Zalieckas
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA
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15
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Contrast-enhanced voiding urosonography (ceVUS) with the intravesical administration of the ultrasound contrast agent Optison™ for vesicoureteral reflux detection in children: a prospective clinical trial. Pediatr Radiol 2018; 48:216-226. [PMID: 29181582 DOI: 10.1007/s00247-017-4026-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/20/2017] [Accepted: 11/03/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Contrast-enhanced voiding urosonography (ceVUS) is widely used outside the United States to diagnose vesicoureteral reflux (VUR) in children and is highly sensitive while avoiding exposure to ionizing radiation. At the onset of this study, two ultrasound (US) contrast agents were available in the United States. Pediatric safety data for intravenous administration was published for one, Optison™. OBJECTIVE This study aimed to evaluate the diagnostic performance and safety of ceVUS using Optison™ and compare its diagnostic efficacy with voiding cystourethrogram (VCUG) for VUR detection and grading in children. MATERIALS AND METHODS The United States Food and Drug Administration and institutional Investigational New Drug authorizations were obtained to conduct a prospective comparative study of ceVUS with Optison™ and VCUG. CeVUS was performed with intravesical administration of 0.2% Optison™/normal saline solution. A standard VCUG followed. Safety assessment included physical examination, and heart rate, pulse oximetry and adverse reactions monitoring before, during and immediately after the examinations. A follow-up questionnaire was completed by telephone 48-h after the studies. RESULTS Sixty-two pelviureteric units were studied in 30 patients with a mean age of 3.5 years (range: 0.1-17 years) including 21 girls and 9 boys. No severe adverse events occurred. All patients had normal heart rate and blood oxygenation saturation prior to, during and after the studies. At the 48-h follow-up, one patient (3.3%) reported transient dysuria. Taking the VCUG as the reference standard, ceVUS had a sensitivity of 91.7% (95%; confidence interval [CI]: 61.5%-99.8%) and specificity of 98% (95%; CI: 89.4%-99.9%). The concordance between ceVUS and VCUG for VUR detection and grading was 84.3% and 81.8%, respectively. VUR grades were discrepant in 4/11 refluxing pelviureteric units, with VCUG upgrading VUR in 2. CONCLUSION Detection of VUR with Optison™ ceVUS was comparable to VCUG without exposure to ionizing radiation. CeVUS with Optison™ is a well-tolerated diagnostic procedure with a favorable safety profile.
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16
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Kramer MR, Bhagat N, Back SJ, Poznick L, Forsberg F, Darge K, Eisenbrey JR. Influence of contrast-enhanced ultrasound administration setups on microbubble enhancement: a focus on pediatric applications. Pediatr Radiol 2018; 48:101-108. [PMID: 28894889 DOI: 10.1007/s00247-017-3976-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/30/2017] [Accepted: 08/25/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In pediatrics, contrast-enhanced ultrasound offers high-quality imaging with an excellent safety profile. OBJECTIVE To investigate the effects of varying intravenous administration setups on in vitro enhancement and concentration of two commercially available ultrasound contrast agents, taking into consideration potential pediatric applications. MATERIALS AND METHODS We quantified in vitro enhancement using a flow phantom (ATS Laboratories, Bridgeport, CT) and Acuson S3000 ultrasound system (Siemens Healthineers, Mountain View, CA) with a 9L4 probe in Cadence pulse sequencing mode. We determined microbubble concentration with an LSRII flow cytometer (BD Biosciences, San Jose, CA). We investigated Optison (GE Healthcare, Princeton, NJ) and Lumason (Bracco, Geneva, Switzerland) ultrasound contrast agents. The ultrasound (US) contrast agent was injected via a 1 mL syringe and flushed with 5 mL of saline through a 22-gauge diffusion catheter (BD Medical, Franklin Lakes, NJ) with the following variations: in-line injection through a 3-way stopcock with and without a neutral displacement connector (ICU Medical, San Clemente, CA), perpendicular through a 3-way stopcock with and without a connector, and without a 3-way stopcock. We also conducted injections through a 22-gauge standard angiocatheter. RESULTS Injection through the connector and perpendicular injection via the 3-way stopcock resulted in significant decreases in enhancement for both ultrasound contrast agents (P<0.0001). Injection through the connector resulted in significant decrease in concentration for Optison (P<0.05). Neither addition of the 3-way stopcock (P>0.24) nor use of a pediatric diffusion catheter (P>0.28) affected the enhancement. CONCLUSION Ultrasound contrast agent enhancement depends on the administration route, although some effects appear to be specific to the ultrasound contrast agent used. To avoid loss of enhancement, neutral displacement connectors and perpendicular injection should be avoided.
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Affiliation(s)
- Michael R Kramer
- School of Medicine, Temple University, Philadelphia, PA, USA.,Department of Radiology, Thomas Jefferson University, 132 South 10th St., Philadelphia, PA, 19107, USA
| | - Nishi Bhagat
- Department of Radiology, Thomas Jefferson University, 132 South 10th St., Philadelphia, PA, 19107, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Poznick
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, 132 South 10th St., Philadelphia, PA, 19107, USA
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, 132 South 10th St., Philadelphia, PA, 19107, USA.
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17
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Anupindi SA, Biko DM, Ntoulia A, Poznick L, Morgan TA, Darge K, Back SJ. Contrast-enhanced US Assessment of Focal Liver Lesions in Children. Radiographics 2017; 37:1632-1647. [DOI: 10.1148/rg.2017170073] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sudha A. Anupindi
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - David M. Biko
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Aikaterini Ntoulia
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Laura Poznick
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Trudy A. Morgan
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Kassa Darge
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Susan J. Back
- From the Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104
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18
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Mattei L, Prada F, Legnani FG, Perin A, Olivi A, DiMeco F. Neurosurgical tools to extend tumor resection in hemispheric low-grade gliomas: conventional and contrast enhanced ultrasonography. Childs Nerv Syst 2016; 32:1907-14. [PMID: 27659832 DOI: 10.1007/s00381-016-3186-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/07/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Pediatric low-grade gliomas (LGGs) are the most frequent solid tumor in childhood. Based on an increasing number of literature reports, maximal safe resection is recommended as the first line of treatment whenever possible. However, distinguishing tumor tissue from the surrounding normal brain is often challenging with infiltrating neoplasms, even with the assistance of intraoperative, microscopic and conventional neuronavigation systems. Therefore, any technique that enhances the detection and visualization of LGGs intraoperatively is certainly desirable. METHODS In this paper, we reviewed the role of intraoperative conventional ultrasound and contrast-enhanced ultrasound (CEUS) as a tool for extending tumor resection in LGGs. Moreover, our experience with this technology is reported and discussed. RESULTS Both B-mode and CEUS are helpful in highlighting LGGs, detecting tumor margins and providing additional information such as vascularization, thus improving the safety of a more radical resection. CONCLUSIONS Although the full potentialities of the method are yet to be explored, intraoperative ultrasound is a promising tool in oncologic surgery and LGG surgery.
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Affiliation(s)
- Luca Mattei
- Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy.
| | - Francesco Prada
- Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy
| | - Federico Giuseppe Legnani
- Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy
| | - Alessandro Perin
- Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy
| | - Alessandro Olivi
- Istituto di Neurochirurgia, Fondazione Policlinico Universitario "A. Gemelli" Università Cattolica e del Sacro Cuore, Largo A. Gemelli 8, 00186, Rome, Italy
| | - Francesco DiMeco
- Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, 21218, USA
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Rafailidis V, Deganello A, Watson T, Sidhu PS, Sellars ME. Enhancing the role of paediatric ultrasound with microbubbles: a review of intravenous applications. Br J Radiol 2016; 90:20160556. [PMID: 27610750 DOI: 10.1259/bjr.20160556] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) represents a complementary technique to greyscale and colour Doppler ultrasonography which allows for real-time visualization and characterization of tissue perfusion. Its inherent advantages in the child makes ultrasonography an ideal imaging modality; repeatability and good tolerance along with the avoidance of CT, a source of ionizing radiation, renders ultrasonography imaging desirable. Although currently paediatric CEUS is principally used in an "off-label" manner, ultrasonography contrast agents have received regulatory approval for assessment of paediatric focal liver lesions (FLL) in the USA. The safety of ultrasound contrast-agents is well documented in adults, as safe as or even surpassing the safety profile of CT and MR contrast agents. Except for the established intracavitary use of CEUS in voiding urosonography, i.v. paediatric applications have been introduced with promising results in the abdominal trauma initial diagnosis and follow-up, characterization and differential diagnosis of FLL and characterization of lung, pleura, renal and splenic pathology. CEUS has also been used to detect complications after paediatric transplantation, evaluate inflammatory bowel disease activity and assess tumour response to antiangiogenic therapy. The purpose of this review was to present these novel i.v. paediatric applications of CEUS and discuss their value.
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Affiliation(s)
- Vasileios Rafailidis
- 1 Department of Radiology, King's College London, King's College Hospital, London, UK
| | - Annamaria Deganello
- 1 Department of Radiology, King's College London, King's College Hospital, London, UK
| | - Tom Watson
- 2 Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Paul S Sidhu
- 1 Department of Radiology, King's College London, King's College Hospital, London, UK
| | - Maria E Sellars
- 1 Department of Radiology, King's College London, King's College Hospital, London, UK
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20
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Use of Quantitative Dynamic Contrast-Enhanced Ultrasound to Assess Response to Antiangiogenic Therapy in Children and Adolescents With Solid Malignancies: A Pilot Study. AJR Am J Roentgenol 2016; 206:933-9. [PMID: 26999488 DOI: 10.2214/ajr.15.15789] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate contrast-enhanced ultrasound assessment of tumor response to antiangiogenic therapy in children and adolescents with solid malignancies. SUBJECTS AND METHODS Children with recurrent solid tumors who were enrolled in an institutional phase 1 study of antiangiogenic therapy underwent contrast-enhanced ultrasound of target lesions before therapy, on therapy days 3 and 7, and at the end of course 1. Acoustic data from target lesion ROIs were used to measure peak enhancement, time to peak, rate of enhancement, total AUC, AUC during wash-in (AUC1), and AUC during washout (AUC2). The Cox regression model was used to assess the association between changes in parameters from baseline to follow-up time points and time to tumor progression. Values of p ≤ 0.050 were considered significant. RESULTS Target lesion sites included liver (n = 3), pleura (n = 2), and supraclavicular mass, soft-tissue component of bone metastasis, lung, retroperitoneum, peritoneum, lymph node, muscle mass, and perineum (n = 1 each). Hazard ratios for changes from baseline to end of course 1 for peak enhancement (1.17, p = 0.034), rate of enhancement (3.25, p = 0.029), and AUC1 (1.02, p = 0.040) were significantly associated with time to progression. Greater decreases in these parameters correlated with longer time to progression. CONCLUSION Contrast-enhanced ultrasound measurements of tumor peak enhancement, rate of enhancement, and AUC1 were early predictors of time to progression in a cohort of children and adolescents with recurrent solid tumors treated with antiangiogenic therapy. Further investigation of these findings in a larger population is warranted.
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21
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Rosado E, Riccabona M. Off-Label Use of Ultrasound Contrast Agents for Intravenous Applications in Children: Analysis of the Existing Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:487-496. [PMID: 26839372 DOI: 10.7863/ultra.15.02030] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to collect and analyze the published data related to intravenous (IV) use of ultrasound (US) contrast agents in children. METHODS We searched the literature to collect all of the published studies reporting the IV administration of a second-generation US contrast agent in children. RESULTS We analyzed 9 case series and 5 case reports, as well as 5 individual cases, of pediatric contrast-enhanced US use reported in a study group that also included adults. We found that 502 children underwent contrast-enhanced US examinations (mean age, 9.7 years; range, 1 day-18 years). Most patients (89%) were injected with the sulfur hexafluoride contrast agent SonoVue (Bracco SpA, Milan, Italy). The mean dose used was 1.5 mL (range, 0.1-9.6 mL). Only 10 patients (2%) had adverse reactions related to the contrast agent administration: 1 life-threatening anaphylactic shock and 9 mild transitory adverse effects. We additionally found 38 papers in which the study groups included at least 1 child; thus, we obtained a total of 540 reported cases of off-label use of IV US contrast agents in children. The most frequent target organ was the liver, and most indications were related to space-occupying lesion characterization and abdominal evaluations after blunt trauma. Some studies also evaluated the diagnostic performance of contrast-enhanced US in different clinical scenarios and found very good accuracy. Concordance between contrast-enhanced US imaging and the respective reference-standard imaging methods ranged between 83% and 100% in different studies. CONCLUSIONS Our results support the idea that the IV use of US contrast agents in children is safe, feasible, diagnostically robust, and effective.
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Affiliation(s)
- Elsa Rosado
- Department of Radiology, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal (E.R.); Department of Radiology, Division of Pediatric Radiology, Universitätsklinikum LKH, Graz, Austria (M.R.).
| | - Michael Riccabona
- Department of Radiology, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal (E.R.); Department of Radiology, Division of Pediatric Radiology, Universitätsklinikum LKH, Graz, Austria (M.R.)
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Contrast-enhanced voiding urosonography: in vitro evaluation of a second-generation ultrasound contrast agent for in vivo optimization. Pediatr Radiol 2015; 45:1496-505. [PMID: 25930084 DOI: 10.1007/s00247-015-3355-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/12/2015] [Accepted: 04/01/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pediatric contrast-enhanced ultrasound (CEUS) is primarily performed outside the United States where a track record for safety in intravenous and intravesical applications has been established. Contrast-enhanced voiding urosonography (ceVUS) has also been shown to have a much higher rate of vesicoureteral reflux detection compared to voiding cystourethrography. US contrast agents available in the United States differ from those abroad. Optison® (GE Healthcare, Princeton, NJ) is such an US contrast agent. While Optison® has similar characteristics to other second-generation agents, it has never been used for ceVUS. In vitro optimization of dose and imaging parameters as well as assessment of contrast visualization when delivered in conditions similar to ceVUS are necessary starting points prior to in vivo applications. OBJECTIVE To optimize the intravesical use of Optison® in vitro for ceVUS before its use in pediatric studies. MATERIALS AND METHODS The experimental design simulated intravesical use. Using 9- and 12-MHz linear transducers, we scanned 20-mL syringes varying mechanical index, US contrast agent concentration (0.25%, 0.5%, 1.0%), solvent (saline, urine, radiographic contrast agent) and time out of refrigeration. We evaluated mechanical index settings and contrast duration, optimized the contrast dose, measured the effect of urine and radiographic contrast agent, and the impact of length of time of contrast outside of the refrigerator on US contrast appearance. We scanned 50-ml saline bags to assess the appearance and duration of US contrast with different delivery systems (injection vs. infusion). RESULTS Consistent contrast visualization was achieved at a mechanical index of 0.06-0.17 and 0.11-0.48 for the L9 and L12 MHz transducers (P < 0.01), respectively. Thus, it was necessary to increase the mechanical index for better contrast visualization of the microbubbles with a higher transducer frequency. The lowest mechanical index for earliest visible microbubble destruction was 0.21 for the 9 MHz and 0.39 for the 12 MHz (P < 0.01) transducers. The 0.5% US contrast agent volume to bladder filling was the most optimal. At this concentration, the mean time to visualize homogenous contrast was 2 min and destruction of approximately half of the microbubbles in the field of view occurred in 7.8 min using the 9-MHz transducer. During contrast infusion, the contrast dose needed to be reduced to 0.12% for maintenance of optimal visualization of microbubbles. There was no deleterious effect on the visualization of contrast in the presence of urine or radiographic contrast agent. Infusion of the US contrast agent speeded visualization of homogeneous enhancement compared with injection. Time outside refrigeration did not affect contrast performance. CONCLUSION Transducer mechanical index settings need to be optimized. A very low dose of the US contrast agent Optison® will suffice for intravesical application, i.e. 0.12% to 0.50% of the bladder filling volume. The presence of urine or radiographic contrast agent did not compromise contrast visualization. The best mode of administration is the infusion method due to fast homogenous distribution at the lowest dose of 0.12%. Leaving the US contrast agent outside the refrigerator for an hour does not affect the microbubbles.
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Kapur J, Oscar H. Contrast-enhanced Ultrasound of Kidneys in Children with Renal Failure. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Piskunowicz M, Kosiak W, Batko T, Piankowski A, Połczyńska K, Adamkiewicz-Drożyńska E. Safety of intravenous application of second-generation ultrasound contrast agent in children: prospective analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1095-1099. [PMID: 25701526 DOI: 10.1016/j.ultrasmedbio.2014.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/05/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
The goal of the work described here was to assess the safety profile of intravenous second-generation ultrasound contrast agents (UCAs) containing sulfur hexafluoride in pediatric contrast-enhanced ultrasound. Between 2010 and 2013, a total of 167 examinations were performed in 137 children referred by the Oncology Department. Approval by an Independent Ethical Review Board on Scientific Research for the intravenous use of an UCA containing sulfur hexafluoride in children with oncologic diseases was obtained. Consent for UCA administration was acquired from the parents or legal guardians. Severe anaphylactic reaction was observed in 0.6% (n = 1). No other adverse events during or after intravenous administration of contrast were observed in the examined group (no changes in heart rate and rhythm, blood pressure, oxygen saturation or respiratory rate). There were no reports of subjective flushing, nausea, transient headaches or altered taste. Although second-generation ultrasound contrast agents are considered potentially safe, all investigators should be prepared for the development of adverse reactions and have provisions in place for all pediatric intravenous contrast-enhanced ultrasound examinations. More multicenter studies are essential to determination of an accurate UCA safety profile.
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Affiliation(s)
| | - Wojciech Kosiak
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Batko
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Arkadiusz Piankowski
- Department of Anesthesiology and Intensive Care, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Połczyńska
- Department of Pediatric Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
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Riccabona M. Why consider contrast-enhanced ultrasound (ce-US) in children?: Editorial comment on: M.M. Woźniak, A. Pawelec, A.P. Wieczorek, M.M. Zajączkowska, H. Borzęcka and P. Nachulewicz 2D/3D/4D contrast-enhanced voiding urosnography in the diagnosis and monitoring of treatment of vesicoureteral reflux in children - can it replace voiding cystourethrography? J Ultrason 2014; 14:447-53. [PMID: 26673607 PMCID: PMC4579718 DOI: 10.15557/jou.2014.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/15/2014] [Accepted: 09/19/2014] [Indexed: 12/27/2022] Open
Affiliation(s)
- Michael Riccabona
- Department of Radiology, Division of Pediatric Radiology, University Hospital LKH Graz, Graz, Austria
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ESPR uroradiology task force imaging recommendations in paediatric uroradiology, part VII: standardised terminology, impact of existing recommendations, and update on contrast-enhanced ultrasound of the paediatric urogenital tract. Pediatr Radiol 2014; 44:1478-84. [PMID: 25331025 DOI: 10.1007/s00247-014-3135-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Abstract
Our purpose is to harmonise and standardise terminology in paediatric uroradiology, to provide and update recommendations for contrast-enhanced US to standardise imaging and encourage further research, and to assess the impact of the existing recommendations in paediatric urogenital imaging. Based on thorough review of literature and variable practice at several centres and after discussion within urogenital imaging groups as well as with other subspecialties, we propose a standardisation of terminology in urogenital imaging. An update with recommendations on paediatric contrast-enhanced US has been issued based on available literature and reports. Finally, a questionnaire has been used to assess the knowledge, applicability and usefulness of, and the adherence to existing recommendations of the European Society of Paediatric Radiology (ESPR) Uroradiology Task Force. In conclusion, the ESPR is working to improve patient safety and optimise paediatric urogenital imaging. Standardisation of terminology and provision of updated knowledge on contrast-enhanced US in childhood will contribute to this task, ideally reducing the need for invasive or radiating imaging. Not all existing recommendations are commonly known, which limits adherence to these recommendations and the availability of comparable data and evidence for future adaptation of imaging strategies in paediatric uroradiology.
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Riccabona M. Basics, principles, techniques and modern methods in paediatric ultrasonography. Eur J Radiol 2014; 83:1487-94. [DOI: 10.1016/j.ejrad.2014.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 11/29/2022]
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Safety of ultrasound contrast agents in the pediatric oncologic population: a single-institution experience. AJR Am J Roentgenol 2014; 202:966-70. [PMID: 24758648 DOI: 10.2214/ajr.13.12010] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Little information is available regarding the safety of ultrasound contrast agents in children. The purpose of this article was to assess the safety profile of the i.v. administration of ultrasound contrast agents in the pediatric oncology population. MATERIALS AND METHODS Patients with pediatric solid malignancies who were enrolled on institutional clinical trials conducted between June 2003 and January 2013 and who met our institutional screening criteria for contrast-enhanced ultrasound (CEUS) were eligible. After providing informed consent or assent for CEUS, subjects received i.v. bolus injections of one of two contrast agents for imaging of the primary tumor or a metastatic target lesion. Hemodynamic parameters, including heart rate, cardiac rhythm, and oxygen saturation, were monitored immediately before and for 30 minutes after the administration of the contrast agent. Interviews with the subject or a guardian were conducted by the principal investigator or a radiologist coinvestigator before and after the examination to assess for any adverse effects. RESULTS Thirty-four subjects (21 male and 13 female) ranging in age from 8 months to 20.7 years (median, 8.7 years) underwent 134 CEUS. No detrimental change in hemodynamic status occurred in any subject. Three subjects (3/134, 2.2%) reported mild transient side effects on one occasion each, two (2/134, 1.5%) had taste alteration, and one (1/134, 0.8%) reported mild transient tinnitus and lightheadedness. These reactions did not recur in these subjects on subsequent CEUS examinations. CONCLUSION The i.v. administration of ultrasound contrast agents is safe and well tolerated in the pediatric oncology population. Further studies in children are needed to confirm our findings.
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Darge K, Papadopoulou F, Ntoulia A, Bulas DI, Coley BD, Fordham LA, Paltiel HJ, McCarville B, Volberg FM, Cosgrove DO, Goldberg BB, Wilson SR, Feinstein SB. 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; 43:1063-73. [PMID: 23843130 DOI: 10.1007/s00247-013-2746-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 12/17/2022]
Abstract
The practice of contrast-enhanced ultrasound in children is in the setting of off-label use or research. The widespread practice of pediatric contrast-enhanced US is primarily in Europe. There is ongoing effort by the Society for Pediatric Radiology (SPR) and International Contrast Ultrasound Society (ICUS) to push for pediatric contrast-enhanced US in the United States. With this in mind, the main objective of this review is to describe the status of US contrast agent safety in non-cardiac applications in children. The five published studies using pediatric intravenous contrast-enhanced US comprise 110 children. There is no mention of adverse events in these studies. From a European survey 948 children can be added. In that survey six minor adverse events were reported in five children. The intravesical administration of US contrast agents for diagnosis of vesicoureteric reflux entails the use of a bladder catheter. Fifteen studies encompassing 2,951 children have evaluated the safety of intravesical US contrast agents in children. A European survey adds 4,131 children to this group. No adverse events could be attributed to the contrast agent. They were most likely related to the bladder catheterization. The existing data on US contrast agent safety in children are encouraging in promoting the widespread use of contrast-enhanced US.
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Affiliation(s)
- Kassa Darge
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Harkanyi Z. Potential Applications of Contrast-enhanced Ultrasound in Pediatric Patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.cult.2013.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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