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Conen P, Thiemann J, Stredele R, Clevert DA. Value of contrast-enhanced sonography in the diagnosis of vesicoureteral reflux. ROFO-FORTSCHR RONTG 2024; 196:1022-1028. [PMID: 38408474 DOI: 10.1055/a-2254-5490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Contrast-enhanced ultrasound of the urinary tract and bladder (ceVUS) is an alternative examination method to micturition cysturethrography (MCU/VCUG) for suspected vesicoureteral reflux (VUR) that is increasing in practice. The purpose of this review is to present the current value of ceVUS in the diagnosis. METHOD A systematic literature search was performed using the keywords "vesicoureteral reflux", "ceVUS", "VCUG" of the databases MEDLINE and Cochrane Library as well as a review of current German, European, and American guidelines on this topic. In addition, recommendations for action in clinical practice were developed. CONCLUSION ceVUS is a quick-to-learn examination method that is equivalent to VCUG for the diagnosis of vesicoureteral reflux and should be used as the diagnostic method of first choice when available given the absence of radiation exposure. KEY POINTS · Like VCUG, ceVUS is the diagnostic method of first choice in suspected vesicoureteral reflux and should be used preferentially given the absence of radiation exposure.. · Especially in comparison to the alternative VCUG, ceVUS is a quick-to-learn examination method.. · ceVUS can also be used to diagnose other pathologies of the lower urinary tract.. CITATION FORMAT · Conen P, Thiemann J, Stredele R et al. Value of contrast-enhanced sonography in the diagnosis of vesicoureteral reflux. Fortschr Röntgenstr 2024; 196: 1022 - 1028.
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Affiliation(s)
- Patrick Conen
- Department of Radiology, Ludwig Maximilians University Munich, München, Germany
- Interdisciplinary Ultrasound-Center, Ludwig Maximilians University Munich, München, Germany
| | - Janine Thiemann
- Department of Radiology, Ludwig Maximilians University Munich, München, Germany
- Interdisciplinary Ultrasound-Center, Ludwig Maximilians University Munich, München, Germany
| | - Regina Stredele
- Department of Urology, Ludwig Maximilians University Munich, München, Germany
| | - Dirk Andre Clevert
- Department of Radiology, Ludwig Maximilians University Munich, München, Germany
- Interdisciplinary Ultrasound-Center, Ludwig Maximilians University Munich, München, Germany
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Spiesecke P, Thiemann J, Conen P, Clevert DA. Contrast enhanced ultrasound of cystic renal lesions, from diagnosis up to treatment. Clin Hemorheol Microcirc 2024:CH248102. [PMID: 39365320 DOI: 10.3233/ch-248102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
Ultrasound is the most used interdisciplinary imaging technique in clinical routine for assessment of renal pathologies. This includes the monitoring of cystic renal lesions, which can be classified as non-complicated or complicated and by means of occurrence as solitary or multifocal lesions. The Bosniak-classification (I-IV) classifies renal cysts in 5 different categories and is used for decisions of further clinical treatment. This classification was developed for computed tomography and has been adopted for magnetic resonance imaging as well as contrast-enhanced ultrasound. In the following review article, cystic kidney lesions and their differentiation using contrast-enhanced ultrasound are presented and an overview of the therapy options is given. In interventional procedures, CEUS can make a valuable contribution in histological sampling, reduce radiation exposure and, under certain circumstances, the number of interventions for the patient.
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Affiliation(s)
- P Spiesecke
- Department of Radiology, Interdisciplinary Ultrasound Center, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J Thiemann
- Department of Radiology, Ludwig-Maximilians-University Munich, Germany
| | - P Conen
- Department of Radiology, Ludwig-Maximilians-University Munich, Germany
| | - D-A Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich, Germany
- Interdisciplinary Ultrasound-Center, Ludwig-Maximilians-University Munich, Germany
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Chen Z, Li X, Chen J, Zheng W, Li Y, Dai Z, Yao C, Lin F, Chen X. Contrast-Enhanced Ultrasound-Guided Endoscopic Retrograde Appendicitis Treatment-A Pilot Study on the Diagnostic and Therapeutic Efficacy in Uncomplicated Appendicitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38943425 DOI: 10.1002/jum.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To determine the diagnostic and therapeutic value of contrast-enhanced ultrasound-guided endoscopic retrograde appendicitis treatment (ERAT) in patients with uncomplicated appendicitis. METHODS A retrospective analysis was performed on clinical and ultrasound data collected from 105 pediatric patients with uncomplicated appendicitis between January 2020 and December 2023. The ultrasound findings before and after treatment, as well as postoperative follow-up and recurrence rates, were summarized and analyzed. RESULTS Successful intubation was achieved in 96 patients (91.4%). The conventional ultrasound appendix visualization rate was 39.6% (38/105), while the appendix visualization rate after contrast-enhanced ultrasound-guidance was 75% (72/105). Contrast-enhanced ultrasound revealed various appendiceal morphologic changes in 89 patients, such as twisting, tortuosity, stiffness, rough inner wall, dilated diameter, and narrowing of the lumen. Additionally, local filling defects, which indicated the presence of fecal stones or debris deposition, were noted in 68 patients. No leakage of the contrast agent occurred. Post-treatment evaluation showed improvement in appendiceal diameter, lumen, and filling defects (P < .01). The follow-up rate was 82 of 89 patients (92.1%), all of whom recovered well without a recurrence. The recurrence rate was 7.9% (7/89). Among the patients with recurrences, five patients resolved after medical treatment and two patients recovered after surgical treatment. CONCLUSION Contrast-enhanced ultrasound-guided ERAT for uncomplicated appendicitis is safe and effective. Specifically, the appendix is increased, which facilitates an evaluation of therapeutic effectiveness. ERAT serves as a valuable supplementary modality to determine the need for surgical treatment of acute appendicitis, which is of significant clinical value.
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Affiliation(s)
- Zekun Chen
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Xingcai Li
- Department of Ultrasound, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Jingfang Chen
- Department of Gastroenterology, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Weikun Zheng
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Yaya Li
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Zeyi Dai
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Caifang Yao
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Feng Lin
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Xiaokang Chen
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
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Fu Y, Zhong J, Tan Y, Zheng T, Liu M, Wang G. Contrast-enhanced ultrasound for differentiating benign from malignant focal solid renal lesions in pediatric patients. Sci Rep 2024; 14:11409. [PMID: 38762673 PMCID: PMC11102535 DOI: 10.1038/s41598-024-62496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/17/2024] [Indexed: 05/20/2024] Open
Abstract
The contrast-enhanced ultrasound (CEUS) has been mainly applied to adults to differentiate benign and malignant renal lesions, however, the characteristics of CEUS in pediatric has not been as well studied as in adults. In the present work, the eligible pediatric patients who underwent renal CEUS between March 2016 and February 2023 were retrospectively analyzed. It included 20 lesions (median diameter, 8.4 cm; range, 1.8-18.0 cm) from 20 patients (median age, 28.0 months; range, 3.0-212.0 months; 9 boys) in malignant group and 5 lesions (median diameter, 3.8 cm; range, 1.3-7.5 cm) from 5 patients (median age, 25.0 months; range, 0.7-216.0 months; 2 boys) in benign group. The diagnostic performance was assessed. Nonparametric and Chi-square tests were performed. With hyperenhancement plus wash-out, CEUS showed a sensitivity of 95.0% [95% confidence interval (CI): 75.1%, 99.9%], a specificity of 80.0% (CI: 28.4%, 99.5%), a positive predictive value of 95.0% (CI: 75.1%, 99.9%) and a negative predictive value of 80.0% (CI: 28.4%, 99.5%). It suggested that CEUS is a valuable technique for identifying between malignant and benign renal lesions in children.
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Affiliation(s)
- Yusi Fu
- Department of Ultrasound Diagnosis, The Second Xiang ya Hospital, Central South University, No 139, Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - Jia Zhong
- Department of Ultrasound, Mawangdui District of Hunan Provincial People's Hospital, Hunan Normal University, No 89, Guhan Road, Changsha, 410000, Hunan, People's Republic of China
| | - Yan Tan
- Department of Ultrasound Diagnosis, The Second Xiang ya Hospital, Central South University, No 139, Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - Taiqing Zheng
- Department of Pathology, Hunan Children's Hospital, No 86, Ziyuan Road, Changsha, 410007, Hunan, People's Republic of China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiang ya Hospital, Central South University, No 139, Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - Guotao Wang
- Department of Ultrasound Diagnosis, The Second Xiang ya Hospital, Central South University, No 139, Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China.
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Matheney T, Shore B, Miller P, Barnewolt C, Kim YJ, Paltiel H. Comparison of Contrast-enhanced Ultrasound and Contrast-enhanced Magnetic Resonance Imaging in the Assessment of Infant Hip Perfusion and Prediction of Proximal Femoral Growth Disturbance Following Closed and Open Reduction for Developmental Dysplasia of the Hip: A Preliminary Study. J Pediatr Orthop 2024; 44:e335-e343. [PMID: 38193395 DOI: 10.1097/bpo.0000000000002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Proximal femoral growth disturbance (PFGD) is a significant complication associated with surgical treatment of infant hip dislocation. Contrast-enhanced magnetic resonance imaging (CEMRI) has been utilized to assess perfusion in these hips and avoid PFGD. Contrast-enhanced ultrasound (CEUS) is an imaging technique utilized to evaluate perfusion in other organs. The aims of this study were to compare perfusion of dysplastic infant hips with CEUS and CEMRI after surgical treatment and to determine whether CEUS was as effective as CEMRI at predicting PFGD. METHODS A retrospective analysis of patients undergoing closed or open reduction for infant hip dislocation between 2012 and 2019 was performed. All patients underwent intraoperative CEUS and postoperative CEMRI to assess femoral epiphyseal perfusion using intravenous contrast. Perfusion status was rated as normal, partially decreased, or globally decreased in both modalities. Agreement in perfusion status between CEUS and CEMRI was assessed. Patients were followed for a minimum of 2 years postoperatively and assessed for PFGD. RESULTS Eighteen patients (28% males) underwent closed or open reduction at an average age of 8 months (3 to 16 mo). The agreement in perfusion status between CEUS and CEMRI was substantial (α = 0.74). Patients were followed for a median of 3 years. PFGD developed in 3 hips (17%). For the detection of PFGD, both imaging modalities performed very well and with no difference in the diagnostic utility of CEUS compared with CEMRI. Considering normal perfusion alone the accuracy, sensitivity, and specificity for CEUS were 83%, 100%, and 80%, and for CEMRI were 78%, 100%, and 73%, respectively. Considering global decreased perfusion alone, the accuracy, sensitivity, and specificity for CEUS were 94%, 67%, and 100%, and for CEMRI were 89%, 67%, and 93%, respectively. CONCLUSIONS CEUS is a viable intraoperative method to assess infant hip perfusion. This pilot study appears to be comparable to CEMRI at visualizing perfusion of infant hips and as good or better in predicting PFGD after hip reduction. Prospective studies of this imaging technique should be performed to confirm the findings of this retrospective review. LEVEL OF EVIDENCE Level II-development diagnostic criteria on the basis of consecutive patients (with generally preferred standard).
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AIUM Practice Parameter for the Performance of Contrast-Enhanced Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:E8-E19. [PMID: 37873725 DOI: 10.1002/jum.16360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/25/2023]
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Ntoulia A, Darge K, Thompson AA, Back SJ. Safety of Ultrasound Contrast Agents in Pediatric Patients With Sickle Cell Disease and Trait. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:189-200. [PMID: 37929626 DOI: 10.1002/jum.16341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 11/07/2023]
Abstract
Ultrasound contrast agent (UCA) use is increasing. Recent isolated reports observed a rise in pain-related adverse events with the intravenous administration of the UCA Definity in adults with sickle cell disease. To date, no studies have investigated the incidence of similar adverse events with UCA Lumason or Optison. We describe our experience regarding the safety of Lumason and Optison in children with sickle cell disease and trait who underwent contrast-enhanced ultrasound exams in our department with intravenous, intravesical, and other intracavitary routes. No pain-related or other adverse events were observed in this pediatric population with any route of UCA administration.
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Affiliation(s)
- Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexis A Thompson
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tüchert SE, Vollert K, Schuster T, Kröncke T. Use of CEUS for Imaging Evaluation of Pediatric Peritonsillar Abscess. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:631-636. [PMID: 36690031 DOI: 10.1055/a-2017-7172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Peritonsillar abscess can be diagnosed by B-mode ultrasound and cross-sectional imaging. The latter (with MRI being the modality of first choice in children) is associated with higher effort and risk for pediatric patients due to the administration of X-rays and/or the need of sedation. The purpose of this study is to evaluate whether the introduction of CEUS into the diagnostic algorithm for suspected pediatric peritonsillar abscess is suitable and advantageous. MATERIALS AND METHODS Single-institution retrospective review of data of pediatric patients who were presented to the department of pediatric radiology for sonographic evaluation under the suspicion of peritonsillar abscess. Diagnostic performance of CEUS was evaluated by using surgical exploration or clinical follow-up as the reference standard. RESULTS 284 children included in the study underwent B-mode ultrasound. Mean age of all patients was 6,23 years. Peritonsillar abscess was the diagnosis in 42 patients. Diagnosis of peritonsillar abscess was made by B-mode ultrasound alone in 13 of 42 patients (31 %). In 17 of 42 patients (40 %), diagnosis was made by a combination of B-mode ultrasound and CEUS. Sensitivity rose from 37 % to 86 % in cases where B-mode ultrasound remained unclear and CEUS was used. CONCLUSION Contrast-enhanced ultrasound (CEUS) is suitable and efficient for the diagnosis of peritonsillar abscess in pediatric patients. It increases the sensitivity for the diagnosis of peritonsillar abscess and thereby reduces the need of additional cross-sectional imaging for the pediatric patients.
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Affiliation(s)
- Stefanie Eliane Tüchert
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Kurt Vollert
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Tobias Schuster
- Department of Pediatric Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Thomas Kröncke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
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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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Juang EK, De Koninck LH, Vuong KS, Gnanaskandan A, Hsiao CT, Averkiou MA. Controlled Hyperthermia With High-Intensity Focused Ultrasound and Ultrasound Contrast Agent Microbubbles in Porcine Liver. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1852-1860. [PMID: 37246049 PMCID: PMC10330369 DOI: 10.1016/j.ultrasmedbio.2023.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/07/2023] [Accepted: 04/25/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The objective of this work was to study microbubble-enhanced temperature elevation with high-intensity focused ultrasound (HIFU) at different acoustic pressures and under image guidance. The microbubbles were administered with either local or vascular injections (that mimic systemic injections) in perfused and non-perfused ex vivo porcine liver under ultrasound image guidance. METHODS Porcine liver was insonified for 30 s with a single-element HIFU transducer (0.9 MHz, 0.413 ms, 82% duty cycle, focal pressures of 0.6-3.5 MPa). Contrast microbubbles were injected either locally or through the vasculature. A needle thermocouple at the focus measured temperature elevation. Diagnostic ultrasound (Philips iU22, C5-1 probe) guided placement of the thermocouple and delivery of microbubbles and monitored the procedure in real time. RESULTS At lower acoustic pressures (0.6 and 1.2 MPa) in non-perfused liver, inertial cavitation of the injected microbubbles led to greater temperatures at the focus compared with HIFU-only treatments. At higher pressures (2.4 and 3.5 MPa) native inertial cavitation in the tissue (without injecting microbubbles) resulted in temperature elevations similar to those after injecting microbubbles. The heated area was larger when using microbubbles at all pressures. In the presence of perfusion, only local injections provided a sufficiently high concentration of microbubbles necessary for significant temperature enhancement. CONCLUSION Local injections of microbubbles provide a higher concentration of microbubbles in a smaller area, avoiding acoustic shadowing, and can lead to higher temperature elevation at lower pressures and increase the size of the heated area at all pressures.
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Affiliation(s)
- Eric K Juang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Lance H De Koninck
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kaleb S Vuong
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Aswin Gnanaskandan
- Department of Mechanical and Materials Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
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Sidhu SD, Joseph S, Dunn E, Cuffari C. The Utility of Contrast Enhanced Ultrasound and Elastography in the Early Detection of Fibro-Stenotic Ileal Strictures in Children with Crohn's Disease. Pediatr Gastroenterol Hepatol Nutr 2023; 26:193-200. [PMID: 37485027 PMCID: PMC10356970 DOI: 10.5223/pghn.2023.26.4.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose Crohn's disease (CD) is a chronic, idiopathic bowel disorder that can progress to partial or complete bowel obstruction. At present, there are no reliable diagnostic tests that can readily distinguish between acute inflammatory, purely fibrotic and mixed inflammatory and fibrotic. Our aim is to study the utility of contrast enhanced ultrasound (CEUS) in combination with shear wave elastography (SWE) to differentiate fibrotic from inflammatory strictures in children with obstructive CD of the terminal ileum. Methods Twenty-five (19 male) children between 2016-2021 with CD of the terminal ileum were recruited into the study. Among these patients, 22 had CEUS kinetic measurements of tissue perfusion, including wash-in slope (dB/sec), peak intensity (dB), time to peak intensity (sec), area under the curve (AUC) (dB sec), and SWE. In total, 11 patients required surgery due to bowel obstruction. Histopathologic analysis was performed by a pathologist who was blinded to the CEUS and SWE test results. Results Patients that underwent surgical resection had significantly higher mean area under the curve on CEUS compared to patients responsive to medical therapy (p=0.03). The AUC also correlated with the degree of hypertrophy and the percent fibrosis of the muscularis propria, as determined by histopathologic grading (p<0.01). There was no difference in the mean elastography measurements between these two patient groups. Conclusion CEUS is a useful radiological technique that can help identify pediatric patients with medically refractory obstructive fibrotic strictures of the terminal ileum that should be considered for early surgical resection.
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Affiliation(s)
- Sarah D. Sidhu
- Pediatric Gastroenterology, Hepatology and Nutrition of Florida, Tampa General Hospital, Temple Terrace, FL, USA
| | - Shelly Joseph
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emily Dunn
- Department of Pediatric Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carmen Cuffari
- Division of Pediatric Gastroenterology and Nutrition, Children’s National Hospital, Washington DC, USA
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Ren J, Ma T, Huang S, Chen G, Dietrich CF, Peng Y, Cui X. A narrative review on the applications of intracavitary contrast-enhanced ultrasonography in pediatric lower genitourinary anomalies. Front Pediatr 2023; 11:984643. [PMID: 37274817 PMCID: PMC10236366 DOI: 10.3389/fped.2023.984643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 04/13/2023] [Indexed: 06/07/2023] Open
Abstract
Purpose We mainly aimed to perform a narrative review of clinical applications of the three intracavitary contrast-enhanced ultrasonography (CEUS) including contrast-enhanced voiding urosonography (ceVUS), contrast-enhanced retrograde urethrosonography (ceRUG), and contrast-enhanced genitosonography (ceGS) in pediatric lower genitourinary anomalies. Method A literature search in the PubMed and Web of Science databases was conducted up to 1 July 2022 on all studies published in English using the search terms "contrast-enhanced voiding urosonography", "contrast-enhanced retrograde urethrosonography", and "contrast-enhanced genitosonography". Trials were limited to pediatric subjects (ages ≤18 years) with no time restrictions. The inclusion criteria were studies on ceVUS, ceRUG, and ceGS to evaluate pediatric lower genitourinary anomalies. Two independent authors summarized the included articles. Results Finally, a total of 48 original articles and 6 case reports or case series were included, of which 50 (93%) were only relevant to ceVUS, 3 (5%) articles involved ceGS, while only one (2%) article involved ceRUG, and 87% of the applications of ceVUS were focused on vesicoureteral reflux (VUR). We also searched 24 related reviews, of which 20 involved ceVUS in diagnosing VUR and 4 involved ceRUG and ceGS for other lower genitourinary anomalies. Conclusion Intracavitary CEUS including ceVUS, ceRUG, and ceGS in pediatrics has many advantages over other radiological examinations in diagnosing lower genitourinary anomalies. Although ceVUS is widely used in detecting VUR, ceRUG and ceGS have also become promising techniques for evaluating the urethral pathologies and urogenital sinus.
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Affiliation(s)
- Jiayu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Ma
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuyan Huang
- Department of Ultrasound, The First People’s Hospital of Huaihua, Huaihua, China
| | - Gongquan Chen
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Yuexiang Peng
- Department of Ultrasound, The Third Hospital of Wuhan, Wuhan, China
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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13
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Tierradentro-García LO, Sridharan A, Hwang M. Transtemporal brain contrast-enhanced ultrasound in children: preliminary experience in patients without neurological disorders. J Ultrasound 2023; 26:201-210. [PMID: 36030353 PMCID: PMC10063714 DOI: 10.1007/s40477-022-00713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/15/2022] [Indexed: 11/24/2022] Open
Abstract
AIM To evaluate the use of transtemporal brain contrast-enhanced ultrasound (CEUS) to assess cerebral blood perfusion in a cohort of children without neurological disorders. METHODS We included pediatric patients who were undergoing a clinically-indicated CEUS study. Brain scans were performed with a Siemens Sequoia scanner and a 4V1 transducer, that was placed on the left transtemporal bone. Brain scans were performed simultaneously with the images of the clinically-indicated organ of interest. Qualitative and quantitative analysis was performed to evaluate the hemispherical blood flow at the level of the midbrain during the wash-in and wash-out phases of the time-intensity curve. Clinical charts were reviewed to evaluate post-CEUS adverse events. RESULTS Five patients were evaluated (mean age 5.8 ± 5.1 years). Qualitatively, more avid enhancement in the midbrain than the cortex was observed. Structures depicted ranged between the centrum semiovale at the level of the lateral ventricles and the midbrain. A quantitative analysis conducted on four patients demonstrated less avid perfusion on the contralateral (i.e. right) side, with a mean left/right ratio ranging between 1.51 and 4.07. In general, there was a steep positive wash-in slope starting at approximately 10 s after contrast injection, reaching a peak intensity around 15-26 s on the left side, and 17-29 s on the right side. No adverse events were reported. CONCLUSION Transtemporal brain CEUS is feasible and safe in the pediatric population and allows qualitative and quantitative assessment of cerebral perfusion.
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Affiliation(s)
| | - Anush Sridharan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA.
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14
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Wilson SR, Merrill CD, Darge K, Barr RG. Increasing CEUS utilization in the USA: a call to action for the adult and pediatric body imaging community. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:418-423. [PMID: 36209254 DOI: 10.1007/s00261-022-03686-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 01/21/2023]
Abstract
Despite its well-established benefits and a powerful body of scientific literature supporting the efficacy of contrast-enhanced ultrasound (CEUS), it has faced challenges in being fully adopted as a diagnostic and problem-solving tool within the USA. This effort, written by experts in performance of and interpretation of CEUS, acts as a roadmap, for those interested in expanding CEUS within their facility. CEUS benefits from a Champion who is knowledgeable and passionate about its performance and who is capable of transferring evidence-based enthusiasm to others. They must be willing to do the legwork required for the successful implementation of a CEUS program, including increasing referrals, expanding applications, and encouraging the inclusion of CEUS into current and established guidelines. The ability of CEUS to resolve a wide range of indeterminate results which come from CT and MR scan represents one of the most compelling arguments for the use of CEUS, decreasing down-stream testing, and reducing time to diagnosis. As utilization grows, the benefits of CEUS will become apparent to other healthcare teams. However, the ultimate beneficiary of improved CEUS utilization will be the patients themselves, who will have greater access to a safe, speedy, cost effective, reliable, and radiation-free diagnostic imaging tool.
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Affiliation(s)
- Stephanie R Wilson
- Departments of Radiology and Medicine, Division of Gastroenterology, Foothills Medical Center, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - Christina D Merrill
- Foothills Medical Center, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Kassa Darge
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia [CHOP], 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA
| | - Richard G Barr
- Northeastern Ohio Medical University, 4209 St, Rootstown, OH, 44272, USA
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15
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Kalayeh K, Fowlkes JB, Claflin J, Fabiilli ML, Schultz WW, Sack BS. Ultrasound Contrast Stability for Urinary Bladder Pressure Measurement. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:136-151. [PMID: 36244919 DOI: 10.1016/j.ultrasmedbio.2022.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/13/2022] [Accepted: 08/08/2022] [Indexed: 06/16/2023]
Abstract
The goal of this study was to evaluate ultrasound contrast microbubbles (MB) stability during a typical cystometrogram (CMG) for bladder pressure measurement application using the subharmonic-aided pressure estimation technique. A detailed study of MB stability was required given two unique characteristics of this application: first, bulk infusion of MBs into the bladder through the CMG infusion system, and second, duration of a typical CMG which may last up to 30 min. To do so, a series of size measurement and contrast-enhanced ultrasound imaging studies under different conditions were performed and the effects of variables that we hypothesized have an effect on MB stability, namely, i) IV bag air headspace, ii) MB dilution factor, and iii) CMG infusion system were investigated. The results verified that air volume in intravenous (IV) bag headspace was not enough to have a significant effect on MB stability during a CMG. We also showed that higher MB dosage results in a more stable condition. Finally, the results indicated that the CMG infusion system adversely affects MB stability. In summary, to ensure MB stability during the entire duration of a CMG, lower filling rates (limited by estimated bladder capacity in clinical applications) and/or higher MB dosage (limited by FDA regulations and shadowing artifact) and/or the consideration of alternative catheter design may be needed.
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Affiliation(s)
- Kourosh Kalayeh
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
| | - Jake Claflin
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mario L Fabiilli
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - William W Schultz
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Bryan S Sack
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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16
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Paraboschi I, Mantica G, Minoli DG, De Marco EA, Gnech M, Bebi C, Manzoni G, Berrettini A. Fluorescence-Guided Surgery and Novel Innovative Technologies for Improved Visualization in Pediatric Urology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811194. [PMID: 36141458 PMCID: PMC9517607 DOI: 10.3390/ijerph191811194] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/27/2022] [Accepted: 09/02/2022] [Indexed: 05/30/2023]
Abstract
Fluorescence-guided surgery (FGS), three-dimensional (3D) imaging technologies, and other innovative devices are rapidly revolutionizing the field of urology, providing surgeons with powerful tools for a more complete understanding of patient-specific anatomy. Today, several new intraoperative imaging technologies and cutting-edge devices are available in adult urology to assist surgeons in delivering personalized interventions. Their applications are also gradually growing in general pediatric surgery, where the detailed visualization of normal and pathological structures has the potential to significantly minimize perioperative complications and improve surgical outcomes. In the field of pediatric urology, FGS, 3D reconstructions and printing technologies, augmented reality (AR) devices, contrast-enhanced ultrasound (CEUS), and intraoperative magnetic resonance imaging (iMRI) have been increasingly adopted for a more realistic understanding of the normal and abnormal anatomy, providing a valuable insight to deliver customized treatments in real time. This narrative review aims to illustrate the main applications of these new technologies and imaging devices in the clinical setting of pediatric urology by selecting, with a strict methodology, the most promising articles published in the international scientific literature on this topic. The purpose is to favor early adoption and stimulate more research on this topic for the benefit of children.
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Affiliation(s)
- Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, 16132 Genoa, Italy
| | - Dario Guido Minoli
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Erika Adalgisa De Marco
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Michele Gnech
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carolina Bebi
- Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gianantonio Manzoni
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alfredo Berrettini
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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17
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Pegoraro F, Giusti G, Giacalone M, Parri N. Contrast-enhanced ultrasound in pediatric blunt abdominal trauma: a systematic review. J Ultrasound 2022; 25:419-427. [PMID: 35040101 PMCID: PMC9402848 DOI: 10.1007/s40477-021-00623-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/03/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Intra-abdominal injury is a major cause of morbidity in children. Computed tomography (CT) is the reference standard for the evaluation of hemodynamically stable abdominal trauma. CT has an increased risk of long-term radiation induced malignancies and a possible risk associated with the use of iodinated contrast media. Contrast-enhanced ultrasound (CEUS) might represent an alternative to CT in stable children with blunt abdominal trauma (BAT). Nonetheless, CEUS in pediatrics remains limited by the lack of strong evidence. The purpose of this study was to offer a systematic review on the use of CEUS in pediatric abdominal trauma. METHODS Electronic search of PubMed, EMBASE and Cochrane databases of studies investigating CEUS for abdominal trauma in children. The risk of bias was assessed using the ROBINS-I tool. RESULTS This systematic review included 7 studies. CEUS was performed with different ultrasound equipment, always with a curvilinear transducer. Six out of seven studies used a second-generation contrast agent. No immediate adverse reactions were reported. The dose of contrast agent and the scanning technique varied between studies. All CEUS exams were performed by radiologists, in the radiology department or at the bedside. No standard training was reported to become competent in CEUS. The range of sensitivity and specificity of CEUS were 85.7 to 100% and 89 to 100%, respectively. CONCLUSION CEUS appears to be safe and accurate to identify abdominal solid organ injuries in children with BAT. Further research is necessary to assess the feasibility of CEUS by non-radiologists, the necessary training, and the benefit-cost ratio of CEUS as a tool to potentially reduce CT scans.
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Affiliation(s)
| | - Giulia Giusti
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Martina Giacalone
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy.
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18
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Gumus M, Oommen KC, Squires JH. Contrast-enhanced ultrasound of the neonatal brain. Pediatr Radiol 2022; 52:837-846. [PMID: 34333692 DOI: 10.1007/s00247-021-05157-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/03/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022]
Abstract
Cranial US is an integral component of evaluating the neonatal brain, especially in the setting of critically ill infants and in the emergency setting, because cranial US can be performed portably at the bedside, is safe, and can be repeated whenever needed. Contrast-enhanced ultrasound (CEUS) involves intravenously injecting microbubbles to allow for improved visibility of large and small vessels to assess vascularity and is becoming a widespread technique to improve diagnostic performance of US across a broad spectrum of applications. CEUS has the potential to add value to routine brain US and become a useful adjunct to MRI in infants in need of bedside imaging. In this review we describe the basics of US contrast agents and CEUS technique, including safety considerations, and detail the potential clinical uses of brain CEUS.
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Affiliation(s)
- Memduha Gumus
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin C Oommen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Judy H Squires
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, 2nd Floor Radiology, 4401 Penn Ave., Pittsburgh, PA, 15224, USA.
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19
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Hwang M, Tierradentro-García LO, Hussaini SH, Cajigas-Loyola SC, Kaplan SL, Otero HJ, Bellah RD. Ultrasound imaging of preterm brain injury: fundamentals and updates. Pediatr Radiol 2022; 52:817-836. [PMID: 34648071 DOI: 10.1007/s00247-021-05191-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
Neurosonography has become an essential tool for diagnosis and serial monitoring of preterm brain injury. Preterm infants are at significantly higher risk of hypoxic-ischemic injury, intraventricular hemorrhage, periventricular leukomalacia and post-hemorrhagic hydrocephalus. Neonatologists have become increasingly dependent on neurosonography to initiate medical and surgical interventions because it can be used at the bedside. While brain MRI is regarded as the gold standard for detecting preterm brain injury, neurosonography offers distinct advantages such as its cost-effectiveness, diagnostic utility and convenience. Neurosonographic signatures associated with poor long-term outcomes shape decisions regarding supportive care, medical or behavioral interventions, and family members' expectations. Within the last decade substantial progress has been made in neurosonography techniques, prompting an updated review of the topic. In addition to the up-to-date summary of neurosonography, this review discusses the potential roles of emerging neurosonography techniques that offer new functional insights into the brain, such as superb microvessel imaging, elastography, three-dimensional ventricular volume assessment, and contrast-enhanced US.
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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.
| | - Luis O Tierradentro-García
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Syed H Hussaini
- 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
| | - Stephanie C Cajigas-Loyola
- 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
| | - Summer L Kaplan
- 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
| | - Hansel J Otero
- 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
| | - Richard D Bellah
- 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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20
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Freeman CW, Hwang M. Advanced Ultrasound Techniques for Neuroimaging in Pediatric Critical Care: A Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:170. [PMID: 35204891 PMCID: PMC8870205 DOI: 10.3390/children9020170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/31/2022]
Abstract
Because of its portability, safety profile, and accessibility, ultrasound has been integral in pediatric neuroimaging. While conventional B-mode and Doppler ultrasound provide anatomic and limited flow information, new and developing advanced ultrasound techniques are facilitating real-time visualization of brain perfusion, microvascular flow, and changes in tissue stiffness in the brain. These techniques, which include contrast-enhanced ultrasound, microvascular imaging, and elastography, are providing new insights into and new methods of evaluating pathologies affecting children requiring critical care, including hypoxic-ischemic encephalopathy, stroke, and hydrocephalus. This review introduces advanced neurosonography techniques and their clinical applications in pediatric neurocritical care.
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Affiliation(s)
- Colbey W. Freeman
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA;
| | - Misun Hwang
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA;
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
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21
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Torres A, Koskinen SK, Gjertsen H, Fischler B. Contrast-enhanced ultrasound is useful for the evaluation of focal liver lesions in children. Australas J Ultrasound Med 2021; 24:143-150. [PMID: 34765424 PMCID: PMC8409441 DOI: 10.1002/ajum.12279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Contrast‐enhanced ultrasound (CEUS) is a widely used diagnostic method. In adults, it has been proven to be a useful alternative to CT and MRI for the characterisation of focal liver lesions (FLLs). However, since there is no official paediatric licensing for any ultrasound contrast agents in Europe, its use has been restricted. Purpose To retrospectively outline our experience with CEUS as a tool for the characterisation of FLLs in paediatric patients. Methods An eleven‐year retrospective single‐centre study. During this period, we identified 287 CEUS examinations performed on children, of these 36 were relevant first‐time examinations with the aim of characterising a focal liver lesion. Clinical and radiological data were collected from the hospital chart. Results The overall agreement between the CEUS diagnosis and the reference diagnosis for benign versus malignant differentiation was 75%. When analysing conclusive CEUS examinations only, the overall agreement was 96%. The specificity for correctly characterising a lesion as benign was 96%, and the negative predictive value was 100%. No side effects from CEUS were detected. Conclusions Our study reinforces that CEUS can be useful in the medical workup for the identification and classification of focal liver lesions in children.
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Affiliation(s)
- Alvaro Torres
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Alfred Nobels alle 8 Huddinge 141 52 Sweden.,Division of Radiology Karolinska University Hospital C1:46 Huddinge Sweden
| | - Seppo K Koskinen
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Alfred Nobels alle 8 Huddinge 141 52 Sweden
| | - Henrik Gjertsen
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Alfred Nobels alle 8 Huddinge 141 52 Sweden.,Division of Transplantation Surgery Karolinska University Hospital Huddinge Stockholm 141 86 Sweden
| | - Björn Fischler
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Alfred Nobels alle 8 Huddinge 141 52 Sweden.,Division of Paediatrics Karolinska University Hospital, Novum Blickagången 6a Huddinge 141 57 Sweden
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22
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Ntoulia A, Aguirre Pascual E, Back SJ, Bellah RD, Beltrán Salazar VP, Chan PKJ, Chow JS, Coca Robinot D, Darge K, Duran C, Epelman M, Ključevšek D, Kwon JK, Sandhu PK, Woźniak MM, Papadopoulou F. Contrast-enhanced voiding urosonography, part 1: vesicoureteral reflux evaluation. Pediatr Radiol 2021; 51:2351-2367. [PMID: 33787945 DOI: 10.1007/s00247-020-04906-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/11/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022]
Abstract
Contrast-enhanced voiding urosonography (ceVUS) is a well-established, sensitive and safe ultrasound (US) modality for detecting and grading vesicoureteral reflux (VUR) and urethral imaging in children. Nearly three decades of remarkable advances in US technology and US contrast agents have refined ceVUS's diagnostic potential. The recent approval of Lumason/SonoVue in the United States, Europe and China for pediatric intravesical applications marked the beginning of a new era for this type of contrast US imaging. Consequently, the use of ceVUS in children has expanded to multiple places around the globe. In the first part of this review article, we describe the current experience in the use of ceVUS for VUR evaluation, with an emphasis on historical background, examination technique, image interpretation and diagnostic accuracy. In the second part, we will present the role of ceVUS for urethral imaging 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.
| | | | - 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
| | - Richard D Bellah
- 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
| | - Viviana P Beltrán Salazar
- Department of Radiology, Hospital Universitari Parc Tauli - Universitat Autónoma de Barcelona, Sabadell, Barcelona, Spain
| | - Pui Kwan Joyce Chan
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong (SAR), People's Republic of China
| | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - David Coca Robinot
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - 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
| | - Carmina Duran
- Department of Radiology, Hospital Universitari Parc Tauli - Universitat Autónoma de Barcelona, Sabadell, Barcelona, Spain
| | - Monica Epelman
- Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Jeannie K Kwon
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Preet Kiran Sandhu
- Department of Radiology, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Magdalena M Woźniak
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland
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23
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Pediatric contrast-enhanced ultrasound: shedding light on the pursuit of approval in the United States. Pediatr Radiol 2021; 51:2128-2138. [PMID: 34117520 DOI: 10.1007/s00247-021-05102-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/10/2021] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
For two decades, pediatric contrast US has been well accepted throughout Europe and other parts of the world outside the United States because of its high diagnostic efficacy and extremely favorable safety profile. This includes intravenous (IV) administration, contrast-enhanced US (CEUS) and the intravesical application, contrast-enhanced voiding urosonography (ceVUS). However, the breakthrough for pediatric contrast US in the United States did not come until 2016, when the U.S. Food and Drug Administration (FDA) approved the first pediatric indication for a US contrast agent. This initial approval covered the use of Lumason (Bracco Diagnostics, Monroe Township, NJ) for the evaluation of focal liver lesions via IV administration in children. A second pediatric indication followed shortly thereafter, when the FDA extended the use of Lumason for assessing known or suspected vesicoureteral reflux via intravesical application in children. Both initial pediatric approvals were granted without prospective pediatric clinical trials, based instead on published literature describing favorable safety and efficacy in children. Three years later, in 2019, the FDA approved Lumason for pediatric echocardiography following a clinical trial involving a total of 12 subjects at 2 sites. The story of how we achieved these FDA approvals spans more than a decade and involves the extraordinary dedication of two professional societies, namely the International Contrast Ultrasound Society (ICUS) and the Society for Pediatric Radiology (SPR). Credit also must be given to the FDA staff for their commitment to the welfare of children and their openness to compelling evidence that contrast US is a safe, reliable, radiation-free imaging option for our pediatric patients. Understanding the history of this approval process will impact the practical application of US contrast agents, particularly when expanding off-label indications in the pediatric population. This article describes the background of the FDA's approval of pediatric contrast US applications to better illuminate the potential pathways to approvals of future indications.
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Starting a pediatric contrast ultrasound service: made simple! Pediatr Radiol 2021; 51:2139-2146. [PMID: 33978800 DOI: 10.1007/s00247-021-04998-w] [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: 10/01/2020] [Revised: 11/17/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
The addition of contrast US to an existing pediatric US service requires several preparatory steps. This overview provides a guide to simplify the process. Initially, it is important to communicate to all stakeholders the justifications for pediatric contrast US, including (1) its comparable or better diagnostic results relative to other modalities; (2) its reduction in procedural sedation or anesthesia by avoiding MRI or CT; (3) its reduction or elimination of radiation exposure by not having to perform fluoroscopy or CT; (4) the higher safety profile of US contrast agents (UCA) compared to other contrast agents; (5) the improved exam comfort and ease inherent to US, leading to better patient and family experience, including bedside US exams for children who cannot be transported; (6) the need for another diagnostic option in light of increasing demand by parents and providers; and (7) its status as an approved and reimbursable exam. It is necessary to have an UCA incorporated into the pharmacy formulary noting that only SonoVue/Lumason is currently approved for pediatric use. In the United States this UCA is approved for intravenous administration for cardiac and liver imaging and for vesicoureteric reflux detection with intravesical application. In Europe and China it is only approved for the intravesical use in children. All other applications are off-label. The US scanner needs to be equipped with contrast-specific software. The UCA has to be prepared just before the exam and it is important to strictly follow the steps as outlined in the packaging inserts in order to prevent premature destruction of the microbubbles. The initial training in contrast US is best focused on the frontline staff actually performing the US studies; these might be sonographers, pediatric or interventional radiologists, or trainees. It is important from the outset to educate the referring physicians about contrast US. It is helpful to participate in existing contrast US courses, particularly those with hands-on components.
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Barr RG, Wilson SR, Lyshchik A, McCarville B, Darge K, Grant E, Robbin M, Wilmann JK, Chong WK, Fleischer A, Paltiel HJ. Contrast -Enhanced Ultrasound: State of the Art in North America. Ultrasound Q 2021; 36:206-217. [PMID: 32890323 DOI: 10.1097/ruq.0000000000000514] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Society of Radiologists in Ultrasound convened a panel of specialists in contrast-enhanced ultrasound (CEUS) to produce a white paper on noncardiac CEUS in North America. The panel met in Chicago, Illinois, on October 24 and 25, 2017. The recommendations are based on analysis of current literature and common practice strategies and are thought to represent a reasonable approach to introduce the advantages of this safe and noninvasive technique for the benefit of our patients. Characterization of liver nodules, and pediatric vascular and intravesicular applications comprise the approved indications for CEUS in the United States. They, along with the very successful off-label use of CEUS for the kidney, are included in this publication.Other off-label uses are presented with emphasis on their value and literature support in the online version.
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Affiliation(s)
| | | | | | | | - Kassa Darge
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Edward Grant
- University of Southern California, Los Angeles, CA
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Utility of contrast-enhanced ultrasound for solid mass surveillance and characterization in children with tuberous sclerosis complex: an initial experience. Pediatr Nephrol 2021; 36:1775-1784. [PMID: 33582872 DOI: 10.1007/s00467-020-04835-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/04/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with tuberous sclerosis complex (TSC) can develop solid kidney masses from childhood. Imaging surveillance is done to detect renal cell carcinoma (RCC) and angiomyolipomas (AML), including AMLs at risk for hemorrhage. Intravenous contrast-enhanced ultrasound (CEUS) may be useful for screening as ultrasound is well tolerated by children and ultrasound contrast agents (UCA) are not nephrotoxic. METHODS Retrospective review of kidney CEUS exams of pediatric TSC patients. Qualitative CEUS analysis by consensus of 3 radiologists assessed rate, intensity, and pattern of lesion enhancement. Quantitative CEUS analysis was performed using Vuebox®. Where available, abdominal MRI was analyzed qualitatively for the same features and quantitatively by in-house-developed software. Time-intensity curves were generated from both CEUS and MRI where possible. Appearance of lesions were compared between CEUS and MRI and histology where available. RESULTS Nine masses in 5 patients included one histologically proven RCC and 8 AMLs diagnosed by imaging. Quantitative CEUS of RCC showed malignant features including increased peak enhancement 162%, rapid wash-in rate 162%, and elevated washout rate 156% compared to normal kidney tissue; versus AML which was 68%, 105%, and 125%, respectively. All masses were hypoenhancing on MRI compared to normal kidney tissue; MR dynamic contrast study offered no distinction between RCC and AML. The only MRI feature differentiating RCC from AML was absence of fat. CONCLUSION Temporal resolution afforded by CEUS was useful to distinguish malignant from benign kidney masses. CEUS may prove useful for screening, characterizing, and follow-up of kidney lesions in pediatric TSC patients.
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Wang G, Xie X, Chen H, Zhong Z, Zhou W, Jiang H, Xie X, Zhou L. Development of a pediatric liver CEUS criterion to classify benign and malignant liver lesions in pediatric patients: a pilot study. Eur Radiol 2021; 31:6747-6757. [PMID: 33666698 DOI: 10.1007/s00330-021-07784-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/09/2020] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To analyze the contrast-enhanced ultrasound (CEUS) characteristics of pediatric patients with focal liver lesions (FLLs) and develop a pediatric liver CEUS criterion to improve the diagnostic performance of CEUS in differentiating pediatric benign and malignant liver lesions. METHODS Between March 2011 and May 2020, patients < 18 years who underwent CEUS were retrospectively evaluated. The CEUS characteristics of FLLs were analyzed. A pediatric liver CEUS criterion categorized as CEUS-1 to CEUS-5 was developed. The diagnostic performance of the criterion (i.e., sensitivity, specificity, PPV, and NPV) was assessed. Chi-square and Mann-Whitney tests were used. RESULTS After exclusion, the study included 130 lesions (mean diameter, 7.1 cm; range, 0.8-17.0 cm) from 130 patients (mean age, 36.0 months; range, 0.03-204.0 months; 74 boys). Hyperenhancement with washout in patients < 5 years or with early washout (≤ 45 s) was used to predict hepatoblastoma, with a sensitivity and specificity of 90.7% (95% confidence interval [CI]: 77.9%, 97.4%) and 93.6% (95% CI: 84.3%, 98.2%), respectively. Peripheral discontinuous globular hyperenhancement was used to diagnose hemangioma, with a sensitivity and specificity of 84.6% (95% CI: 65.1%, 95.6%) and 100% (95% CI: 95.4%, 100.0%), respectively. The rates of malignancies within the pediatric liver CEUS-1, CEUS-2, CEUS-3, CEUS-4, and CEUS-5 categories were 0.0%, 0.0%, 5.6%, 50.0%, and 96.1%, respectively. Besides, the incidences of hepatoblastoma in pediatric liver CEUS-3, CEUS-4, and CEUS-5 were 5.6%, 16.7%, and 67.5%, respectively. CONCLUSIONS The pediatric liver CEUS criterion is useful in differentiating benign focal liver lesions from malignancies, especially hepatoblastoma from hemangioma. KEY POINTS • Hyperenhancement with washout in patients <v5 years or with early washout (≤ 45 s) were used to predict hepatoblastoma, with a sensitivity and specificity of 90.7% and 93.6%. • Peripheral discontinuous globular hyperenhancement was used to diagnose hemangioma, with a sensitivity and specificity of 84.6% and 100.0%. • The rates of malignancies within the pediatric liver CEUS-1, CEUS -2, CEUS-3, CEUS-4, and CEUS-5 categories were 0.0%, 0.0%, 5.6%, 50.0%, and 96.1%, respectively.
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Affiliation(s)
- Guotao Wang
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Xiaohua Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Huadong Chen
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Zhihai Zhong
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Wenying Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Hong Jiang
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Luyao Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.
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Evaluation of the Diagnostic Value of Contrast-Enhanced Voiding Urosonography with Regard to the Further Therapy Regime and Patient Outcome-A Single-Center Experience in an Interdisciplinary Uroradiological Setting. ACTA ACUST UNITED AC 2021; 57:medicina57010056. [PMID: 33435420 PMCID: PMC7826578 DOI: 10.3390/medicina57010056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 01/11/2023]
Abstract
Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.
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Bowen DK, Back SJ, Van Batavia JP, Darge K, Long CJ, Weiss DA. Does contrast-enhanced ultrasound have a role in evaluation and management of pediatric renal trauma? A preliminary experience. J Pediatr Surg 2020; 55:2740-2745. [PMID: 32674845 DOI: 10.1016/j.jpedsurg.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND To report our initial experience using intravenous contrast-enhanced ultrasound (CEUS) in pediatric renal trauma with the potential for substantial radiation reduction. METHODS A retrospective review of all patients who underwent intravenous CEUS at our institution between May 2015 and January 2018 for the suspicion of blunt renal trauma. CEUS was obtained either as an immediate or short-term comparison to contrast-enhanced computed tomography (CECT), or in outpatient follow-up. RESULTS CEUS was performed on 7 patients (9 kidneys) with age range 2 months to 16 years old. CEUS was utilized as a comparison to CECT in 4 of 7 patients for initial evaluation, clinical change, or short-term follow-up. CEUS alone was used in one patient with low suspicion for renal injury. In the remaining two patients, CEUS was obtained as a follow-up study weeks after the initial CECT, following conservative management. All patients with confirmed renal injury by CECT (n = 5) underwent a follow-up CEUS at 1-2 months. CONCLUSIONS In an era of conservative management for renal trauma in which operative intervention is dictated more often by the clinical course than radiographic findings, it is reasonable to consider alternative imaging methods such as CEUS in stable patients to decrease radiation exposure. LEVEL OF EVIDENCE RATING IV.
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Affiliation(s)
- Diana K Bowen
- Division of Pediatric Urology, Department of Pediatric Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Susan J Back
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Jason P Van Batavia
- Division of Pediatric Urology, Department of Pediatric Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Kassa Darge
- Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Christopher J Long
- Division of Pediatric Urology, Department of Pediatric Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Dana A Weiss
- Division of Pediatric Urology, Department of Pediatric Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
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Marschner CA, Rübenthaler J, Froelich MF, Schwarze V, Clevert DA. Benefits of contrast-enhanced ultrasonography for interventional procedures. Ultrasonography 2020; 40:207-216. [PMID: 33530676 PMCID: PMC7994736 DOI: 10.14366/usg.20083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
For evaluating unclear tumorous lesions, contrast-enhanced ultrasonography (CEUS) is an important imaging modality in addition to contrast-enhanced computed tomography and magnetic resonance imaging, and may provide valuable insights into the microvascularization of tumors in dynamic examinations. In interventional procedures, CEUS can make a valuable contribution in pre-, peri-, and post-interventional settings, reduce radiation exposure and, under certain circumstances, decrease the number of interventions needed for patients.
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Affiliation(s)
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Matthias Frank Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Vincent Schwarze
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver - Update 2020 - WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:562-585. [PMID: 32707595 DOI: 10.1055/a-1177-0530] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Johann Wolfgang Goethe Universitätsklinik Frankfurt, Germany
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA and Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Dept Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy and BIOMAPS. Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center For Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milano, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2579-2604. [PMID: 32713788 DOI: 10.1016/j.ultrasmedbio.2020.04.030] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland; Johann Wolfgang Goethe Universitätsklinik, Frankfurt, Germany.
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G. B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, California, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy and BIOMAPS, Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, United Kingdom
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milan, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Sekej M, Vadnjal Đonlagić S, Ključevšek D. Contrast-Enhanced Ultrasound for the Characterization of Infantile Hepatic Hemangioma in Premature Neonate. Cureus 2020; 12:e9580. [PMID: 32923186 PMCID: PMC7478462 DOI: 10.7759/cureus.9580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Contrast-enhanced ultrasonography (CEUS) is a relatively new imaging method for use in children. It is recognized as a safe and easily performed problem-solving method. A premature 10-day-old female infant experienced unusual persistent anemia. The diagnostic workup for the anemia included an abdominal ultrasound examination, which showed pathological formation in the left middle quadrant. MRI was used to further asses the lesion and showed a hypervascular lesion with necrotic areas rising from the left hepatic lobe, mainly showing the pattern that indicates an infantile hepatic hemangioma. Main differential diagnosis, hepatoblastoma, could not be excluded. The crucial examination used to differentiate was CEUS.
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Affiliation(s)
- Marjan Sekej
- Radiology, University Medical Centre Maribor, Maribor, SVN
| | | | - Damjana Ključevšek
- Pediatric Radiology, University Medical Centre Ljubljana, Ljubljana, SVN
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Evaluation of the Reproducibility of Bolus Transit Quantification With Contrast-Enhanced Ultrasound Across Multiple Scanners and Analysis Software Packages—A Quantitative Imaging Biomarker Alliance Study. Invest Radiol 2020; 55:643-656. [DOI: 10.1097/rli.0000000000000702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Trikoupi G, Papadopoulou P, Papadopoulou F, Theodoridis A, Papazoglou L, Patsikas M. Contrast-enhanced voiding urosonography: A new, radiation-free, alternative method for imaging of urinary bladder and urethra in healthy dogs. Vet Radiol Ultrasound 2020; 61:453-460. [PMID: 32462691 DOI: 10.1111/vru.12867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced voiding urosonography (CE-VUS) has been generally considered as a promising tool to diagnose vesicoureteral reflux and abnormalities in lower urinary tract in human patients, especially in children. The purpose of this prospective study is to evaluate the quality of images of the urinary bladder and urethra obtained by CE-VUS using a second-generation ultrasound contrast agent (SonoVue®) in healthy dogs and to investigate the safety profile of SonoVue® after intravesical administration. Eighty-four CE-VUS examinations with SonoVue® were successfully performed in both unsedated (39/84) and sedated (45/84) dogs. Contrast-enhanced voiding urosonography examination of urinary bladder was technically successful in all (84/84) dogs. The image quality was not considered adequate in five (5/84) dogs including three dogs in whom layering of contrast media during filling phase was observed and two dogs with premature destruction of microbubbles. In these five dogs, the problem was readily recognized and corrected such that the procedure was still successfully undertaken. The assessment of the urethra during spontaneous micturition was successfully performed in all (84/84) dogs in whom voiding was elicited during the examination. No side effects were observed after intravesical application of SonoVue®. This study demonstrates that CE-VUS is a feasible and valuable technique to evaluate low urinary tract morphology and function in dogs. Based on our review of the literature, there are no published reports about the use of this method in dogs.
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Affiliation(s)
- Georgia Trikoupi
- School of Veterinary Medicine, Aristotle University of Thessaloniki, Stavrou Voutira, Thessaloniki, Greece
| | - Paraskevi Papadopoulou
- School of Veterinary Medicine, Aristotle University of Thessaloniki, Stavrou Voutira, Thessaloniki, Greece
| | | | - Alexandros Theodoridis
- School of Veterinary Medicine, Aristotle University of Thessaloniki, Stavrou Voutira, Thessaloniki, Greece
| | - Lysimachos Papazoglou
- School of Veterinary Medicine, Aristotle University of Thessaloniki, Stavrou Voutira, Thessaloniki, Greece
| | - Michael Patsikas
- School of Veterinary Medicine, Aristotle University of Thessaloniki, Stavrou Voutira, Thessaloniki, Greece
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Ključevšek D, Riccabona M, Ording Müller LS, Woźniak MM, Franchi-Abella S, Darge K, Mentzel HJ, Ntoulia A, Avni FE, Napolitano M, Lobo L, Littooij AS, Augdal TA, Bruno C, Damasio BM, Ibe D, Stafrace S, Petit P. Intracavitary contrast-enhanced ultrasonography in children: review with procedural recommendations and clinical applications from the European Society of Paediatric Radiology abdominal imaging task force. Pediatr Radiol 2020; 50:596-606. [PMID: 32055916 DOI: 10.1007/s00247-019-04611-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/03/2019] [Accepted: 12/30/2019] [Indexed: 12/18/2022]
Abstract
Contrast-enhanced ultrasonography (US) has become an important supplementary tool in many clinical applications in children. Contrast-enhanced voiding urosonography and intravenous US contrast agents have proved useful in routine clinical practice. Other applications of intracavitary contrast-enhanced US, particularly in children, have not been widely investigated but could serve as a practical and radiation-free problem-solver in several clinical settings. Intracavitary contrast-enhanced US is a real-time imaging modality similar to fluoroscopy with iodinated contrast agent. The US contrast agent solution is administered into physiological or non-physiological body cavities. There is no definitive list of established indications for intracavitary US contrast agent application. However, intracavitary contrast-enhanced US can be used for many clinical applications. It offers excellent real-time spatial resolution and allows for a more accurate delineation of the cavity anatomy, including the internal architecture of complex collections and possible communications within the cavity or with the surrounding structures through fistulous tracts. It can provide valuable information related to the insertion of catheters and tubes, and identify related complications such as confirming the position and patency of a catheter and identifying causes for drainage dysfunction or leakage. Patency of the ureter and biliary ducts can be evaluated, too. US contrast agent solution can be administered orally or a via nasogastric tube, or as an enema to evaluate the gastrointestinal tract. In this review we present potential clinical applications and procedural and dose recommendations regarding intracavitary contrast-enhanced ultrasonography.
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Affiliation(s)
- Damjana Ključevšek
- Department of Radiology, University Children's Hospital,, University Medical Center Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia.
| | - Michael Riccabona
- Department of Radiology, Division of Pediatric Radiology, University Hospital LKH Graz and Medical University Graz, Graz, Austria
| | - Lil-Sofie Ording Müller
- Division of Radiology and Nuclear Medicine, Department of Paediatric Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Stéphanie Franchi-Abella
- Service de Radiopédiatrie, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology,, University Hospital Jena, Jena, Germany
| | | | - Fred Efraim Avni
- Department of Pediatric Radiology, Jeanne de Flandre Hospital,, Lille University Hospitals, Lille, France
| | - Marcello Napolitano
- Department of Pediatric Radiology and Neuroradiology,, V. Buzzi Children's Hospital, Milan, Italy
| | - Luisa Lobo
- Department of Radiology, Hospital de Santa Maria-CHLN, University Hospital, Lisbon, Portugal
| | - Annemieke Simone Littooij
- Princess Maxima Center for Pediatric Oncology,, Wilhelmina Children's Hospital Utrecht/UMCU, Utrecht, the Netherlands
| | | | - Costanza Bruno
- Radiology Institute, Department of Radiology, AOUI, Verona, Italy
| | | | - Donald Ibe
- Radiology Department, Silhouette Diagnostic Consultants,, Wuse 2, Abuja, Nigeria
| | - Samuel Stafrace
- Department of Diagnostic Imaging, Sidra Medicine, Doha, Qatar
| | - Philippe Petit
- Service d'Imagerie Pédiatrique et Prénatale, Hôpital Timone Enfants, Marseille, France
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AIUM Practice Parameter for the Performance of Contrast-Enhanced Ultrasound Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:421-429. [PMID: 31930582 DOI: 10.1002/jum.15204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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European Society of Paediatric Radiology abdominal imaging task force: recommendations for contrast-enhanced ultrasound and diffusion-weighted imaging in focal renal lesions in children. Pediatr Radiol 2020; 50:297-304. [PMID: 31776600 DOI: 10.1007/s00247-019-04552-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/17/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) and diffusion-weighted imaging (DWI) are safe, repeatable imaging techniques. The aim of this paper is to discuss the advantages, technical factors and possible clinical applications of these imaging tools in focal renal lesions in children.
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Back SJ, Chauvin NA, Ntoulia A, Ho-Fung VM, Calle Toro JS, Sridharan A, Morgan TA, Kozak B, Darge K, Sankar WN. Intraoperative Contrast-Enhanced Ultrasound Imaging of Femoral Head Perfusion in Developmental Dysplasia of the Hip: A Feasibility Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:247-257. [PMID: 31334874 DOI: 10.1002/jum.15097] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/21/2019] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Developmental dysplasia of the hip (DDH) is one of the most common developmental deformities of the lower extremity. Although many children are successfully treated with a brace or harness, some require intraoperative closed or open reduction and spica casting. Surgical reduction is largely successful to relocate the hip; however, iatrogenic avascular necrosis is a major source of morbidity. Recent research showed that postoperative gadolinium-enhanced magnetic resonance imaging (MRI) can depict hip perfusion, which may predict a future incidence of avascular necrosis. As contrast-enhanced ultrasound (CEUS) assesses blood flow in real time, it may be an effective intraoperative alternative to evaluate femoral head perfusion. Here we describe our initial experience regarding the feasibility of intraoperative CEUS of the hip for the assessment of femoral head perfusion before and after DDH reduction. METHODS This single-institution retrospective Institutional Review Board-approved study with a waiver of informed consent evaluated intraoperative hip CEUS in children with DDH compared to postoperative contrast-enhanced MRI. Pediatric radiologists, blinded to prior imaging findings and outcomes, reviewed both CEUS and MRI examinations separately and some time from the initial examination both independently and in consensus. RESULTS Seventeen patients had 20 intraoperative CEUS examinations. Twelve of 17 (70.6%) had prereduction hip CEUS, postreduction hip CEUS, and postreduction gadolinium-enhanced MRI. Seven of 12 (58.3%) were evaluable retrospectively. All CEUS studies showed blood flow in the femoral epiphysis before and after reduction, and all MRI studies showed femoral head enhancement after reduction. The CEUS and MRI for all 7 patients also showed physeal blood flow. CONCLUSIONS Contrast-enhanced ultrasound is a feasible intraoperative tool for assessing adequate blood flow after hip reduction surgery in DDH.
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Affiliation(s)
- Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy A Chauvin
- Department of Radiology, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Victor M Ho-Fung
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juan S Calle Toro
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anush Sridharan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Trudy A Morgan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brandi Kozak
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wudbhav N Sankar
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mao M, Xia B, Chen W, Gao X, Yang J, Li S, Wang B, Mai H, Liu S, Wen F, Gan Y, Song J, Wei H, Yang W, Wu Y, Yang S, Yu W, Yu H, Fan S, Tao H, Feng X, Lin Z, Liu L. The Safety and Effectiveness of Intravenous Contrast-Enhanced Sonography in Chinese Children-A Single Center and Prospective Study in China. Front Pharmacol 2019; 10:1447. [PMID: 31866865 PMCID: PMC6906782 DOI: 10.3389/fphar.2019.01447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022] Open
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.
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Affiliation(s)
- Muyi Mao
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Bei Xia
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Weiling Chen
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaojie Gao
- Department of Nephrology and Hematology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jun Yang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, Shenzhen, China
| | - Shoulin Li
- Department of Urinary Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Bin Wang
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Huirong Mai
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Sixi Liu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Feiqiu Wen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yungen Gan
- Radiology Department, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianming Song
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, China
| | - Hong Wei
- Drug Clinical Trial Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Weiguo Yang
- Intensive Care Unit, Shenzhen Children's Hospital, Shenzhen, China
| | - Yuhui Wu
- Intensive Care Unit, Shenzhen Children's Hospital, Shenzhen, China
| | - Shufang Yang
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Wei Yu
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Hongkui Yu
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Shumin Fan
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Hongwei Tao
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Xia Feng
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Zhou Lin
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
| | - Lei Liu
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
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Barr RG. Just Because There is a Button Doesn't Mean it is Appropriate to Use or That it will Give Accurate Information. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1139. [PMID: 30897227 DOI: 10.1002/jum.14990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Richard G Barr
- Professor of Radiology, Northeastern Ohio Medical University
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Torres A, Koskinen SK, Gjertsen H, Fischler B. Contrast-Enhanced Ultrasound for identifying circulatory complications after liver transplants in children. Pediatr Transplant 2019; 23:e13327. [PMID: 30536767 DOI: 10.1111/petr.13327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022]
Abstract
Our main goal with this study was to share our off-label experience with CEUS for identifying circulatory complications after liver transplantation in children. A total of 74 CEUS examinations performed on 34 pediatric patients who underwent a liver transplant were retrospectively included. About 53% of the examinations were performed on children 2 years old or younger. About 82% of the examinations were performed within 30 days from the transplant. About 62% of patients were transplanted due to a cholestatic disease, 11% due to a metabolic disease, 8% were re-transplanted due to graft failure, and 19% was due to other conditions. BA was the most common reason for transplantation and represented 38% of patients. About 38% of the transplantations were performed with whole grafts from DD, 40% with split liver grafts, and 22% with left lateral segments from LD. For diagnosing arterial circulatory complications, the PPV was 80%. For diagnosing portal vein circulatory complications, the PPV was 66.7%. NPV was 100%. In 28% of the examinations, the examiner could not visualize the normal arterial blood flow without CEUS. CEUS is a non-invasive and safe imaging technique that seems valuable in these patients and further efforts are needed to license its use in the post-transplant setting.
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Affiliation(s)
- Alvaro Torres
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Seppo K Koskinen
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Henrik Gjertsen
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Björn Fischler
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Karolinska University Hospital, Huddinge, Sweden
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Zhang XR, Ouyang J, Huang JY. Comparison of CEUS and enhanced CT in evaluating efficacy of TACE for hepatocellular carcinoma. Shijie Huaren Xiaohua Zazhi 2019; 27:63-67. [DOI: 10.11569/wcjd.v27.i1.63] [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] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the value of contrast-enhanced ultrasound (CEUS) and enhanced computed tomography (CT) in evaluating the efficacy of transcatheter artery chemoembolization (TACE) for hepatocellular carcinoma (HCC).
METHODS A total of 96 patients with HCC who underwent TACE at Zhejiang Tumor Hospital were selected as research subjects (a total of 128 lesions). Digital subtraction angiography (DSA), CEUS, and enhanced CT were performed one month after operation, and the results of DSA were used as the "gold standard" to compare the clinical value of CEUS and enhanced CT in evaluating the efficacy of TACE.
RESULTS The sensitivity (95.18%) and accuracy (95.31%) of CEUS in the diagnosis of residual lesions were higher than those (84.34% and 88.28%, respectively) of enhanced CT (P < 0.05). The specificities of CEUS and enhanced CT in the diagnosis of residual lesions were both 95.56%, and there was no significant difference between them (P > 0.05).
CONCLUSION CEUS can accurately evaluate the residual lesions of HCC after TACE and has appreciated clinical value, thus providing a reliable imaging method for evaluating the efficacy of TACE.
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Affiliation(s)
- Xin-Rong Zhang
- Department of Ultrasonography, Deqing People's Hospital, Huzhou 313200, Zhejiang Province, China
| | - Jun Ouyang
- Department of Ultrasonography, Deqing People's Hospital, Huzhou 313200, Zhejiang Province, China
| | - Jing-Yuan Huang
- Department of Ultrasonography, Shulan (Hangzhou) Hospital, Hangzhou 310022, Zhejiang Province, China
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46
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Ključevšek D, Pečanac O, Tomažič M, Glušič M. Potential causes of insufficient bladder contrast opacification and premature microbubble destruction during contrast-enhanced voiding urosonography in children. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:36-41. [PMID: 30393874 DOI: 10.1002/jcu.22656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 09/14/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
Contrast-enhanced voiding urosonography (ceVUS) has been recognized as a child-friendly examination with high diagnostic accuracy for vesicoureteric reflux detection. A single bolus and the infusion techniques of ceVUS are described. Insufficient bladder contrast opacification during the filling phase and premature destruction of SonoVue microbubbles might occur. Data regarding SonoVue's features, doses, bladder contrast opacification, US bladder parameters, urine catheter, antibiotic prophylaxis, and childrens behaviors were collected to discover the possible causes of the contrast vanishing observed during bladder filling in 10% of examinations and in the later phase of ceVUS in 5% of examinations. An updated ceVUS examination protocol is suggested.
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Affiliation(s)
- Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Slovenia
| | - Olivera Pečanac
- Department of Radiology, University Children's Hospital Ljubljana, Slovenia
| | - Mojca Tomažič
- Department of Radiology, University Children's Hospital Ljubljana, Slovenia
| | - Mojca Glušič
- Department of Radiology, University Children's Hospital Ljubljana, Slovenia
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47
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Thimm MA, Rhee D, Takemoto CM, Karnsakul W, Cuffari C, Guerrerio AL, Garcia A, Gearhart J, Huisman TAGM, Hwang M. Diagnosis of congenital and acquired focal lesions in the neck, abdomen, and pelvis with contrast-enhanced ultrasound: a pictorial essay. Eur J Pediatr 2018; 177:1459-1470. [PMID: 29971555 DOI: 10.1007/s00431-018-3197-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/30/2018] [Accepted: 06/19/2018] [Indexed: 01/17/2023]
Abstract
UNLABELLED Contrast-enhanced ultrasound (CEUS) is a versatile imaging modality that improves the diagnostic potential of conventional ultrasound. It allows for portable imaging at the bedside. In this paper, we illustrate how CEUS can be used in evaluating several focal lesions in the pediatric population, including liver hemangioma, telangiectasias, splenic hamartomas, and bladder lesions. We describe the ultrasound findings and contrast enhancement patterns associated with these lesions. Findings are correlated with MRI, CT, and/or pathology when available. This paper demonstrates the value of CEUS in improving characterization of many focal lesions in the pediatric population. CONCLUSION CEUS is a valuable bedside technique for use in the pediatric population to evaluate focal lesions in various organs, and will allow for safe, more efficient diagnostic imaging. What is Known: • CEUS offers many advantages over CT and MRI and is underutilized in the United States. • It is only FDA approved for vesicoureteral reflux and liver in the pediatric population. However, off label uses are well described. What is New: • This pictorial essay describes ultrasound findings and contrast enhancement patterns associated with liver hemangioma, liver telangiectasia, splenic hamartoma, hemorrhagic ovarian cyst, urachal remnant, spinning top urethras, and kaposiform hemangioendothelioma. • We demonstrate the utility of CEUS in expanding the diagnostic potential of conventional ultrasound.
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Affiliation(s)
- Matthew A Thimm
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Rhee
- Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Clifford M Takemoto
- Division of Pediatric Hematology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wikrom Karnsakul
- Division of Pediatric Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carmen Cuffari
- Division of Pediatric Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anthony L Guerrerio
- Division of Pediatric Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alejandro Garcia
- Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - John Gearhart
- Division of Pediatric Urology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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48
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Khanna R, Verma SK. Pediatric hepatocellular carcinoma. World J Gastroenterol 2018; 24:3980-3999. [PMID: 30254403 PMCID: PMC6148423 DOI: 10.3748/wjg.v24.i35.3980] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
Pediatric hepatocellular carcinoma (HCC) is the second common malignant liver tumor in children after hepatoblastoma. It differs from the adult HCC in the etiological predisposition, biological behavior and lower frequency of cirrhosis. Perinatally acquired hepatitis-B virus, hepatorenal tyrosinemia, progressive familial intrahepatic cholestasis, glycogen storage disease, Alagille’s syndrome and congenital portosystemic shunts are important predisposing factors. Majority of children (87%) are older than 5 years of age. Following mass immunization against hepatitis-B, there has been a drastic fall in the incidence of new cases of pediatric HCC in the Asia-Pacific region. Management is targeted on complete surgical removal either by resection or liver transplantation. There is a trend towards improving survival of children transplanted for HCC beyond Milan criteria. Chemotherapeutic regimens do not offer good results but may be helpful for down-staging of advanced HCC. Surveillance of children with chronic liver diseases with ultrasound and alpha-fetoprotein may be helpful in timely detection, intervention and overall improvement in outcome of HCC.
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Affiliation(s)
- Rajeev Khanna
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Sanjeev Kumar Verma
- Department of Pediatrics, King George Medical University, Uttar Pradesh 226003, India
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49
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Woźniak MM, Osemlak P, Ntoulia A, Borzęcka H, Bieniaś B, Brodzisz A, Jędrzejewski G, Drelich-Zbroja A, Powerski M, Pech M, Wieczorek AP. 3D/4D contrast-enhanced urosonography (ceVUS) in children - is it superior to the 2D technique? J Ultrason 2018; 18:120-125. [PMID: 30335920 PMCID: PMC6440503 DOI: 10.15557/jou.2018.0017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 11/22/2022] Open
Abstract
Background: By now, two-dimensional contrast-enhanced voiding urosonography (ceVUS) has become a well-established method for the diagnosis and treatment monitoring of vesicoureteral reflux in children, particularly after the recent approval for this application in children in the USA and in Europe. The introduction of three-dimensional static (3D) and real-time (4D) techniques with ultrasound contrast agents opens up new diagnostic opportunities for this imaging modality. Objective: To analyze whether 3D and 4D ceVUS is a superior technique compared to standard 2D ceVUS in diagnosing vesicoureteral reflux in children. Material and methods: The study included 150 patients (mean age 3.7 years) who underwent 2D and 3D/4D ceVUS for the diagnosis and grading of vesicoureteral reflux. Results: 2D ceVUS and 3D/4D ceVUS diagnosed the same number of vesicoureteral refluxes, however, there was a statistically significant difference in grading between the two methods. Performing 3D/4D ceVUS resulted in changing the initial grade compared to 2D ceVUS in 19 out of 107 refluxing units (17.76%) diagnosed. The 4D technique enabled a more conspicuous visualization of vesicoureteral reflux than the 3D technique. Conclusions: 2D ceVUS and 3D/4D ceVUS diagnosed the same number of vesicoureteral refluxes, however, there was a statistically significant difference in grading between the two methods. Thus 3D/4D ceVUS appears at least a valid, if not even a more conspicuous technique compared to 2D ceVUS.
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Affiliation(s)
| | - Paweł Osemlak
- Department of Pediatric Surgery and Traumatology, Medical University of Lublin, Lublin, Poland
| | - Aikaterini Ntoulia
- Department of Radiology Children's Hospital of Philadelphia, Philadelphia, USA
| | - Halina Borzęcka
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Beata Bieniaś
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Brodzisz
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland
| | | | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
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50
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Pediatric contrast-enhanced ultrasound in the United States: a survey by the Contrast-Enhanced Ultrasound Task Force of the Society for Pediatric Radiology. Pediatr Radiol 2018; 48:852-857. [PMID: 29442152 DOI: 10.1007/s00247-018-4088-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/22/2017] [Accepted: 01/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The United States Food and Drug Administration (FDA) recently approved an ultrasound (US) contrast agent for intravenous and intravesical administration in children. OBJECTIVE Survey the usage, interest in and barriers for contrast-enhanced US among pediatric radiologists. MATERIALS AND METHODS The Contrast-Enhanced Ultrasound Task Force of the Society for Pediatric Radiology (SPR) surveyed the membership of the SPR in January 2017 regarding their current use and opinions about contrast-enhanced US in pediatrics. RESULTS The majority (51.1%, 166) of the 325 respondents (26.7% of 1,218) practice in either a university- or academic affiliated group. The most widely used US contrast agent was Lumason® 52.3% (23/44). While lack of expertise and training were reported barriers, all respondents who are not currently using US contrast agents are considering future use. CONCLUSION Interest in pediatric contrast US is very high. Education and training are needed to support members who plan to adopt contrast US into practice.
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