title: Contrast enhanced ultrasound for the evaluation of blunt pediatric abdominal trauma.
abstract: BACKGROUND
  Blunt abdominal trauma is a common problem in children. Computed tomography (CT) is the gold standard for imaging in pediatric blunt abdominal trauma, however up to 50% of CTs are normal and CT carries a risk of radiation-induced cancer. Contrast enhanced ultrasound (CEUS) may allow accurate detection of abdominal organ injuries while eliminating exposure to ionizing radiation.
  
  
  METHODS
  Children aged 7-18years with a CT-diagnosed abdominal solid organ injury underwent grayscale/power Doppler ultrasound (conventional US) and CEUS within 48h of injury. Two blinded radiologists underwent a brief training in CEUS and then interpreted the CEUS images without patient interaction. Conventional US and CEUS images were compared to CT for the presence of injury and, if present, the injury grade. Patients were monitored for contrast-related adverse reactions.
  
  
  RESULTS
  Twenty one injured organs were identified by CT in eighteen children. Conventional US identified the injuries with a sensitivity of 45.2%, which increased to 85.7% using CEUS. The specificity of conventional US was 96.4% and increased to 98.6% using CEUS. The positive predictive value increased from 79.2% to 94.7% and the negative predictive value from 85.3% to 95.8%. Two patients had injuries that were missed by both radiologists on CEUS. In a 100kg, 17year old female, a grade III liver injury was not seen by either radiologist on CEUS. Her accompanying grade I kidney injury was not seen by one of the radiologist on CEUS. The second patient, a 16year old female, had a grade III splenic injury that was missed by both radiologists on CEUS. She also had an adjacent grade II kidney injury that was seen by both. Injuries, when noted, were graded within 1 grade of CT 33/35 times with CEUS. There were no adverse reactions to the contrast.
  
  
  CONCLUSIONS
  CEUS is a promising imaging modality that can detect most abdominal solid organ injuries in children while eliminating exposure to ionizing radiation. A multicenter trial is warranted before widespread use can be recommended.
  
  
  METHODS
  Level II; Diagnostic Prospective Study.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA. Electronic address: lindsey.bendure@childrens.harvard.edu.
authors.forename: Lindsey B
authors.initials: LB
authors.lastname: Armstrong
authors.affiliation: Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Mooney
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
authors.forename: Harriet
authors.initials: H
authors.lastname: Paltiel
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Barnewolt
authors.affiliation: Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Dionigi
authors.affiliation: Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Arbuthnot
authors.affiliation: Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
authors.forename: Chinwendu
authors.initials: C
authors.lastname: Onwubiko
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Connolly
authors.affiliation: Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
authors.forename: Delma Y
authors.initials: DY
authors.lastname: Jarrett
authors.affiliation: Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Zalieckas
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D003287:Contrast Media; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries; D008099:Liver / Q000293:injuries; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen / Q000293:injuries; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media
keywords: Contrast ultrasound; Pediatric abdominal trauma