CEUS shows promise for pediatric patients


In her presentation, Dr. Susan Back of Children’s Hospital of Philadelphia presented case studies of CEUS in action to diagnose pediatric patients of various ages, from young children to adolescent athletes.

“Ultrasound, I think, is always a first option for pediatrics in almost everything,” Back said. AuntMinnie.com. “If you have a clinician who has a question that can be answered quickly and easily by ultrasound, it saves the child from having to undergo sedation or an X-ray.”

The researchers touted CEUS for using no radiation and providing real-time imaging as a vascular tracer using gas-filled microbubbles. Previous studies suggest that CEUS outperforms standard ultrasound and color Doppler in some imaging areas.

However, a debate on the use of contrast products persists among medical imagers. Barriers to its use noted by experts include workflow challenges, a “black box” warning issued by the U.S. Food and Drug Administration (FDA), and requiring sonographers to acquire new skills.

Dr. Susan Back speaks about new imaging techniques in pediatric ultrasound at the annual meeting of the American Institute of Ultrasound in Medicine (AIUM). She said that while contrast-enhanced ultrasound shows promise in pediatric imaging, more evidence-based research needs to be presented for wider use.

Over the years, several companies have urged the FDA to withdraw their warnings, including the AIUM, the World Federation of Ultrasound in Medicine and Biology, and the Society of Ultrasound Radiologists, among others.

Back said there is also a need for more researchers to present their findings.

“The more evidence-based use we have, the easier it will be for those addressing these challenges,” she said. “For those of us who have the ability to use off-label contrast, [we need to] being able to speak with our clinical partners to understand the questions that need to be answered.”

A case report presented by Back showed scans of a one-year-old boy who had swelling in his arm. A contrast agent was injected which showed no flow around a catheter which was also used. This gave clinicians confidence to say there was a glandular thrombus around the catheter, which guided treatment.

Another case report showed a 15-year-old soccer player who presented with abdominal trauma after sustaining an injury. Ultrasound showed hematoma and renal extravasation. ECUS was used for monitoring as the teenager’s hemoglobin was stabilizing. Clinicians determined he did not need embolization or surgery, and CEUS later showed internal healing.

A third report presented by Back showed an infantile hemangioma in a 6-week-old girl with the use of high-frequency ultrasound and color Doppler. Liver ultrasound was also used, with MRI additionally used to ensure that there were no deeper hemangiomas. CEUS also proved the results to be consistent with an infantile hemangioma. Back said the girl periodically returns for an evaluation.

Back said CEUS can help where other imaging modalities such as CT or MRI cannot with pediatric patients, as well as save on expenses for families. She added that contrast agents have a variety of clinical uses.

“There are lots of ways to use contrast and lots of promise,” Back said. AuntMinnie.com. “Anything new takes time to gain acceptance, but if we can improve patient value and benefit, that should be our priority.”

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