Use of contrast-enhanced ultrasound in pediatrics

Although contrast-enhanced ultrasound has been shown to provide considerable benefits, particularly in pediatric patients, it is still used relatively rarely in Brazil. It has proven to be a safe technique, and adverse effects are rare. In this review, we address the technique and main applications of contrast-enhanced ultrasound in the pediatric population, including the evaluation of focal liver lesions, abdominal trauma, kidney grafts, liver grafts, bowel loops, and vesicoureteral reflux. It is important for pediatric radiologists to be acquainted with this promising tool, understanding its applications and limitations.

Keywords:
Pediatrics; Ultrasonography; Contrast media; Microbubbles

Authorship

Marcelo Straus Takahashi Correspondence: Dr. Marcelo Straus Takahashi. InRad/HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César. São Paulo, SP, Brazil, 05403-010. Email: straus91@gmail.com.

Instituto de Radiologiado do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilInstituto de Radiologiado do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.

Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilInstituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP), São Paulo, SP, Brazil.

http://orcid.org/0000-0001-9489-2844

Mauricio Gustavo Ieri Yamanari

http://orcid.org/0000-0002-8394-8029

Lisa Suzuki

http://orcid.org/0000-0001-6045-0191

Ésio Fortaleza Nascimento Chaves Pedrosa

http://orcid.org/0000-0001-6820-8658

Roberto Iglesias Lopes

Pediatric Urology Sector, Department of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilPediatric Urology Sector, Department of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil.

http://orcid.org/0000-0002-6636-7679

Maria Cristina Chammas

http://orcid.org/0000-0001-7041-3079

Correspondence: Dr. Marcelo Straus Takahashi. InRad/HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César. São Paulo, SP, Brazil, 05403-010. Email: straus91@gmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (7)

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Figure 1
A 14-year-old patient with a liver nodule identified as an incidental finding on ultrasound. A: Simultaneous B-mode and Doppler intensity ultrasound images (left and right, respectively), showing a nodule (arrows on the left) that is slightly hypoechoic in relation to the liver parenchyma, with a hypoechoic center (central scar; arrowhead on the left). On the color Doppler image, a central artery appears as a star-shaped image (arrows on the right). B: After administration of the contrast medium, ultrasound showed a central artery in a star shape (arrows). C: Subsequent centrifugal enhancement, with complete contrast filling and persistence in the delayed phases (arrows).

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Figure 2
A 12-year-old patent with chronic liver disease and multiple nodules on ultrasound. A: B-mode ultrasound showing multiple hypoechoic nodules (arrows). B: On contrast-enhanced ultrasound, note that the enhancement of the nodules is similar to that of the adjacent liver parenchyma, on the arterial, portal venous, and delayed-phase images, without washout, consistent with regenerative nodules.

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Figure 3
A seven-year-old patient with a history of resected right adrenal carcinoma. A follow-up conventional ultrasound scan had detected hypoechoic and heterogeneous nodules. Contrast-enhanced ultrasound showing lesions with early washout in relation to the liver parenchyma (arrows), consistent with metastasis.

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Figure 4
A nine-year-old patient with abdominal trauma from a domestic accident. A: Conventional ultrasound showing slightly hypoechoic and heterogeneous areas in the right lobe of the liver, with ill-defined borders (arrows). B: After administration of contrast medium, ultrasound clearly showed a laceration in the right lobe (arrows). C: Computed tomography scan acquired on the same day, showing lacerations (arrows).

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Figure 5
Quantitative assessment of perfusion without signs of graft dysfunction in a patient who underwent kidney transplantation. Note the homogeneous contrast enhancement of the graft, the enhancement curves showing a preserved time to peak, without perfusion asymmetry between the renal cortex and the renal pyramids.

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Figure 6
A 15-year-old patient, under follow-up treatment for Crohn’s disease, with abdominal pain and suspected exacerbation of the disease. Images after intravenous injection of microbubble contrast medium, showing wall thickening of the sigmoid loop (arrows) on B-mode ultrasound; in the contrast-specific mode, note the intense microbubble contrast parietal enhancement of the loop (open arrows). The anechoic structure at the bottom of the image is the full bladder (asterisks).

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Figure 7
A three-month-old patient undergoing investigation of vesicoureteral reflux. A: Voiding cystourethrography showing vesicoureteral reflux with filling of the renal pelvis and calyces by contrast medium (arrow). B: Voiding urosonography in the contrast-specific mode, showing reflux of microbubble contrast medium (injected through the bladder catheter) to the renal pelvis (arrows).

Figure 1 A 14-year-old patient with a liver nodule identified as an incidental finding on ultrasound. A: Simultaneous B-mode and Doppler intensity ultrasound images (left and right, respectively), showing a nodule (arrows on the left) that is slightly hypoechoic in relation to the liver parenchyma, with a hypoechoic center (central scar; arrowhead on the left). On the color Doppler image, a central artery appears as a star-shaped image (arrows on the right). B: After administration of the contrast medium, ultrasound showed a central artery in a star shape (arrows). C: Subsequent centrifugal enhancement, with complete contrast filling and persistence in the delayed phases (arrows).

Figure 2 A 12-year-old patent with chronic liver disease and multiple nodules on ultrasound. A: B-mode ultrasound showing multiple hypoechoic nodules (arrows). B: On contrast-enhanced ultrasound, note that the enhancement of the nodules is similar to that of the adjacent liver parenchyma, on the arterial, portal venous, and delayed-phase images, without washout, consistent with regenerative nodules.

Figure 3 A seven-year-old patient with a history of resected right adrenal carcinoma. A follow-up conventional ultrasound scan had detected hypoechoic and heterogeneous nodules. Contrast-enhanced ultrasound showing lesions with early washout in relation to the liver parenchyma (arrows), consistent with metastasis.

Figure 4 A nine-year-old patient with abdominal trauma from a domestic accident. A: Conventional ultrasound showing slightly hypoechoic and heterogeneous areas in the right lobe of the liver, with ill-defined borders (arrows). B: After administration of contrast medium, ultrasound clearly showed a laceration in the right lobe (arrows). C: Computed tomography scan acquired on the same day, showing lacerations (arrows).

Figure 5 Quantitative assessment of perfusion without signs of graft dysfunction in a patient who underwent kidney transplantation. Note the homogeneous contrast enhancement of the graft, the enhancement curves showing a preserved time to peak, without perfusion asymmetry between the renal cortex and the renal pyramids.

Figure 6 A 15-year-old patient, under follow-up treatment for Crohn’s disease, with abdominal pain and suspected exacerbation of the disease. Images after intravenous injection of microbubble contrast medium, showing wall thickening of the sigmoid loop (arrows) on B-mode ultrasound; in the contrast-specific mode, note the intense microbubble contrast parietal enhancement of the loop (open arrows). The anechoic structure at the bottom of the image is the full bladder (asterisks).

Figure 7 A three-month-old patient undergoing investigation of vesicoureteral reflux. A: Voiding cystourethrography showing vesicoureteral reflux with filling of the renal pelvis and calyces by contrast medium (arrow). B: Voiding urosonography in the contrast-specific mode, showing reflux of microbubble contrast medium (injected through the bladder catheter) to the renal pelvis (arrows).

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Use of contrast-enhanced ultrasound in pediatrics

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[1] Correspondence: Dr. Marcelo Straus Takahashi. InRad/HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César. São Paulo, SP, Brazil, 05403-010. Email: straus91@gmail.com.