title: Accuracy of contrast-enhanced ultrasound (CEUS) in the identification and characterization of traumatic solid organ lesions in children: a retrospective comparison with baseline US and CE-MDCT.
abstract: BACKGROUND
  Localized low-energy abdominal trauma is very frequent in the pediatric population. The findings of several studies have shown that ultrasonography (US) can represent a useful and cost-effective tool in the evaluation of blunt abdominal trauma both in adults and children. However, many parenchymal injuries are not correctly visualized at baseline US examination. The introduction of specific US contrast agents contrast-enhanced ultrasound (CEUS) has enabled a better identification of traumatic organ injuries. The correct use of CEUS could therefore identify and select the children who need further diagnostic investigation computed tomography (CT), avoiding unnecessary radiation and iodinated contrast medium exposure. The purpose of our study was to assess the sensibility and feasibility of CEUS in the assessment of low-energy abdominal trauma compared to baseline US in pediatric patients, using contrast-enhanced MDCT as the reference standard.
  
  
  METHODS
  We retrospectively reviewed 73 children (51 M and 22 F; mean age 8.7 ± 2.8 years) who presented in our Emergency Department between October 2012 and October 2013, with history of minor abdominal trauma according to the Abbreviated Injury Scale and who underwent US, CEUS, and CE-MDCT. Inclusion criteria were: male or female, aged 0-16, hemodynamically stable patients with a history of minor blunt abdominal trauma. Exclusion criteria were adulthood, hemodynamical instability, history of major trauma. Sensitivity, specificity, PPV, NPV, and accuracy were determined for US and CEUS compared to MDCT.
  
  
  RESULTS
  6/73 patients were negative at US, CEUS, and MDCT for the presence of organ injuries. In the remaining 67 patients, US depicted 26/67 parenchymal lesions. CEUS identified 67/67 patients (67/67) with parenchymal lesions: 21 lesions of the liver (28.8 %), 26 lesions of the spleen (35.6 %), 7 lesions of right kidney (9.6 %), 13 lesions of left kidney. MDCT confirmed all parenchymal lesions (67/67). Thus, the diagnostic performance of CEUS was better than that of US, as sensitivity, specificity, PPV, NPV, and accuracy were 100, 100, 100, 100, and 100 % for CEUS and 38.8, 100, 100, 12.8, and 44 % for US. In some patients CEUS identified also prognostic factors as parenchymal active bleeding in 8 cases, partial devascularization in 1 case; no cases of vascular bleeding, no cases of urinoma. MDCT confirmed all parenchymal lesions. Parenchymal active bleeding was identified in 16 cases, vascular bleeding in 2 cases, urinoma in 2 cases, partial devascularization in 1 case.
  
  
  CONCLUSIONS
  CEUS is more sensitive and accurate than baseline US and almost as sensitive as CT in the identification and characterization of solid organs lesions in blunt abdominal trauma. CT is more sensitive and accurate than CEUS in identifying prognostic indicators, as active bleeding and urinoma. CEUS should be considered as a useful tool in the assessment and monitoring of blunt abdominal trauma in children.
authors.affiliation: Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy.
authors.forename: Guendalina
authors.initials: G
authors.lastname: Menichini
authors.affiliation: Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sessa
authors.affiliation: Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Trinci
authors.affiliation: Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Galluzzo
authors.affiliation: Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy. vmiele@sirm.org.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Miele
mesh_terms: D015998:Abbreviated Injury Scale; D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D002648:Child; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media
keywords: Blunt abdominal trauma; Children minor trauma; Contrast media; Contrast-enhanced ultrasound; Emergency radiology; Multidetector computed tomography; Solid organ injury
references.citation: AJR Am J Roentgenol. 2000 Jun;174(6):1613-6
references.pmid: 10845493
references.citation: Radiol Med. 2007 Jun;112(4):581-7
references.pmid: 17563847
references.citation: Diagn Interv Radiol. 2005 Mar;11(1):41-4
references.pmid: 15795843
references.citation: Eur J Radiol. 2004 Jul;51(1):91-6
references.pmid: 15186891
references.citation: Radiology. 2002 Mar;222(3):749-54
references.pmid: 11867796
references.citation: Radiology. 2003 Apr;227(1):95-103
references.pmid: 12616002
references.citation: Radiol Med. 2015 Feb;120(2):180-9
references.pmid: 24961341
references.citation: Ann Emerg Med. 2004 Feb;43(2):278-90
references.pmid: 14747821
references.citation: Radiol Med. 2015 Jan;120(1):33-49
references.pmid: 25376101
references.citation: Radiol Med. 2004 Jul-Aug;108(1-2):82-91
references.pmid: 15269692
references.citation: Acta Radiol. 2014 Sep;55(7):776-84
references.pmid: 24060814
references.citation: J Trauma. 1997 Apr;42(4):617-23; discussion 623-5
references.pmid: 9137247
references.citation: J Pediatr Surg. 2001 Apr;36(4):565-9
references.pmid: 11283878
references.citation: AJR Am J Roentgenol. 2004 Nov;183(5):1293-301
references.pmid: 15505293
references.citation: J Clin Ultrasound. 2004 Feb;32(2):53-61
references.pmid: 14750135
references.citation: Radiology. 1998 Jan;206(1):137-42
references.pmid: 9423663
references.citation: Radiographics. 2001 Oct;21 Spec No:S191-9
references.pmid: 11598257
references.citation: Emerg Radiol. 2007 Jul;14 (3):135-41
references.pmid: 17564732
references.citation: Radiology. 1999 Aug;212(2):423-30
references.pmid: 10429699
references.citation: Radiology. 1989 Apr;171(1):33-9
references.pmid: 2928544
references.citation: Semin Ultrasound CT MR. 2007 Apr;28(2):130-40
references.pmid: 17432767
references.citation: AJR Am J Roentgenol. 2006 May;186(5):1361-7
references.pmid: 16632732
references.citation: AJR Am J Roentgenol. 1997 Jan;168(1):207-12
references.pmid: 8976947
references.citation: Radiology. 2012 Dec;265(3):678-93
references.pmid: 23175542
references.citation: J Trauma. 1985 Jan;25(1):60-4
references.pmid: 3965737
references.citation: J Pediatr Surg. 1995 Dec;30(12 ):1644-8
references.pmid: 8749914
references.citation: Radiology. 2008 Mar;246(3):903-9
references.pmid: 18195385
references.citation: Am Surg. 2000 Nov;66(11):1049-55
references.pmid: 11090017
references.citation: Pediatr Radiol. 2012 Dec;42(12):1471-80
references.pmid: 23052725
references.citation: Radiol Med. 2015 Jan;120(1):3-11
references.pmid: 25142944
references.citation: Radiology. 2000 Oct;217(1):75-82
references.pmid: 11012426
references.citation: Radiology. 2000 Nov;217(2):426-9
references.pmid: 11058639
references.citation: AJR Am J Roentgenol. 2007 Feb;188(2):415-21
references.pmid: 17242250