Spectrum, Applicability and Diagnostic Capacity of Contrast-Enhanced Ultrasound in Pediatric Patients and Young Adults after Intravenous Application - A Retrospective Trial.
Purpose:To investigate the spectrum, applicability and diagnostic capacity of intravenous contrast-enhanced ultrasound imaging (CEUS) in a pediatric population.Materials and Methods:From 08/2005 to 11/2015, n = 40 pediatric patients and young adults from 0 - 26 years (Ø 11.4 ± 7.5) and 3.0 - 85.3 kg (Ø 40.8 ± 25.6) with n = 55 investigations received n = 79 IV applications of ultrasound contrast agent (UCA). UCA dose and side effects were documented. Scanned organs were the liver (n = 42), spleen (n = 9), kidney (n = 3), and testis (n = 1). Histology, surgery or reference imaging was compared to CEUS and clinical follow-up.Results:The UCA dose < 20 kg was 0.4 ± 0.3 ml, (0.05 ± 0.02 ml/kg) and > 20 kg was 1.0 ± 0.4 ml (p< 0.0001) (0.02 ± 0.01 ml/kg, p< 0.0001). Adverse effects occurred in 2/79 applications (2.5 %). Agreement CEUS/gold standard resulted in 32/34 investigations. For liver diagnostics (gold standard: MRI, CT, histology, serology), n = 11 malignant and n = 15 benign focal liver lesions were included. The specificity was 100 % (95 % CI: 0.77 - 1.00), the sensitivity was 82 % (95 % CI: 0.48 - 0.98), the positive predictive value was 100 % (95 % CI: 0.69 - 1.00) and the negative predictive value was 88 % (95 % CI: 0.62 - 0.98, p< 0.0001). In n = 2 reference imaging misdiagnosed and CEUS was in accordance with clinical follow-up. All splenic/renal lesions were diagnosed correctly. In n = 1 an insufficient testicular perfusion was ruled out. The observation time was 30.4 ± 30.5 months.Conclusion:CEUS is a well-tolerated and diagnostically equivalent modality in pediatric care, providing fundamental advantages compared to currently approved imaging modalities for these age groups.
Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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F
Knieling
Medical Department 1, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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D
Strobel
Department of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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O
Rompel
Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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M
Zapke
Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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C
Menendez-Castro
Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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M
Wölfel
Children's Hospital, Department for Pediatric Oncology and Hematology, Campus Virchow Clinic, Charité, Berlin, Germany.
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J
Schulz
Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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W
Rascher
Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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J
Jüngert
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging*; D008099:Liver / Q000000981:diagnostic imaging*; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging*; D013737:Testis / Q000000981:diagnostic imaging*; D055815:Young Adult
D003287:Contrast Media