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Contrast-Enhanced Ultrasound Promotes the Detection of Medical Conditions in Children

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Digital radiography newsContrast-enhanced ultrasound (CEUS) can safely improve the diagnosis of a variety of medical conditions in children without exposing them to ionizing radiation, a new research shows.

Dr. Martin Stenzel, a pediatric radiologist at the University Hospital in Jena, Germany, mentioned that no adverse safety events were found when CEUS was used to screen 50 pediatric patients at his hospital. Stenzel highlighted his results at the 16th European Symposium on Ultrasound Contrast Imaging in Rotterdam, Netherlands on January 2011.

"Our experience shows that this technology works in children as well as adults," Dr. Stenzel reported.

Co-sponsored by the International Contrast Ultrasound Society (ICUS), the conference featured the latest research and clinical improvements in the CEUS field.

Radiation exposure is associated with an increased lifetime risk of cancer. According to Dr. Stenzel, ultrasound scans do not subject patients to ionizing radiation unlike computed tomography (CT) and nuclear imaging.  He also explained “It is especially important to avoid subjecting children to diagnostic tests that use ionizing radiation because children have many years to live and the risk of cancer is cumulative. In addition, we do not know how ionizing radiation may affect future reproductive capacity or the impact it may have on their unborn children.”

The technique is suitable for screening young patients who will not need to stay still, since CEUS images are not jeopardized through patient movement. Dr. Stenzel said “This avoids the need for sedating children prior to imaging." Stenzel and his colleagues used CEUS to distinguish between benign cyst and a perfused tumor, which could be quite dangerous and need immediate treatment. This helps avoid invasive tissue sampling, which presents additional risks and can be more difficult in children than in adults.

According to Dr. Stenzel, severe forms of kidney infections can be assessed more accurately with CEUS, which can help doctors to diagnose tiny abscesses or pus formation that would need strong antibiotic treatment. CEUS is “especially helpful” in assessing an organ’s blood flow (perfusion). “Bowel and testicular torsion, or twisting--typical diseases of the younger child--are medical emergencies in which confident ultrasound results will prevent unnecessary surgical explorations," Dr. Stenzel added.

He reported that CEUS was useful in diagnosing internal abdominal injuries resulting from a fall during play.

Moreover, Dr. Stenzel said that CEUS is safe, accurate, and less expensive than alternative imaging techniques. For validating the use of CEUS in pediatric patients, he called for additional clinical trials.

The first- line screening tool that is used to detect a large variety of medical conditions throughout the body is the traditional ultrasound. During an ultrasound examination, ultrasound contrast agents may be used to promote the quality and accuracy of a conventional ultrasound image. They consist of suspensions of biocompatible and biodegradable micro-bubbles that are smaller than red blood cells. Contrary to agents used in MRI and angiography procedures, ultrasound contrast agents do not comprise dye, which may produce allergic reactions in some patients. 

After an ultrasound contrast agent is injected into a patient’s arm vein, it flows through the circulatory system, mimicking the flow patterns of red blood cells while reflecting ultrasound signals. An ultrasound probe is placed over a region of interest, for instance the abdomen or heart, then it will pick up the reflected signals and transmit them to a moving, real-time image of the target organ system. The contrast agent is essentially breathed out of the body only few minutes after injection.

Finally, ultrasound contrast agents have been approved to be used in adult patients only. According to Dr. Stenzel, their use in children is off-label and needs more investigation. CEUS is used to improve certain forms of cardiac imaging in the United States. While in Europe, Canada, Asia, and Brazil it is used for evaluating medical conditions throughout the body including the heart, liver, brain, digestive tract, and kidneys.

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