EuroSafe Imaging 2020
Action 7 - Radiation protection of children, Contrast agents, Ultrasound, Contrast agent-intravenous, Diagnostic procedure, Tissue characterisation, Transplantation, Trauma, Retrospective, Observational, Multicentre study
V. Rafailidis, G. Yusuf, C. F. Dietrich, A. Deganello, M. Sellars, P. Sidhu
Ultrasound (US) is undoubtedly a crucial modality for paediatric Radiology, with inherent advantages including lack of ionizing radiation, good patient tolerability and widespread availability. Nevertheless, there are clinical settings where it cannot fully address the clinical inquiry, for example in focal liver lesion characterization or confident assessment of tissue perfusion or ischemia. Computed tomography (CT) and Magnetic Resonance (MR) Imaging are then performed as a second step modality to further assess suspicious US findings, with both imaging modalities with inherent disadvantages. CT imaging is associated with ionizing radiation and a related risk for cancer development, in children requires sedation for optimal image quality and makes use of a nephrotoxic contrast agent. MR imaging may require sedation and entails the use of gadolinium contrast agents, associated with possible long-term adverse effects. All these aspects drive the need for reduction of use of CT and MR imaging in children and use of alternative techniques [1-10].
The introduction of ultrasound contrast agents (UCA) introduced a new complementary US technique: contrast-enhanced ultrasound (CEUS). CEUS has been widely adopted following technological advances and extensively studied in many applications in the adult population, which has ultimately lead to the publication of official guidelines and recommendations . Although the evolution of CEUS in adult applications has been impressive, progress has been slower in the paediatric population attributable to the fact that CEUS is still performed in an “off-label” manner. SonoVueTM (Bracco, SpA, Milan) is the most commonly used UCA. CEUS is currently approved for investigation of the vesico-ureteral reflux in children (using SonoVueTM), and has been widely applied for this clinical indication. SonoVueTM (or Lumason™) was recently approved in the USA by the FDA for the characterization of focal liver lesion in both adults and children; the first ‘official’ intravenous application in children. The intravenous application of SonoVueTM is not approved in Europe. Despite this “off-label” nature, studies are abundant in Europe demonstrating that intravenous CEUS examinations can be safely performed in paediatric patients and offers improved diagnostic accuracy over conventional US, potentially negating the use of CT and MR imaging. The literature available for paediatric applications of CEUS has been summarized in a European Federation of Ultrasound in Medicine and Biology (EFSUMB) position statement on paediatric CEUS .
The EFSUMB recently created the “EFSUMB Paediatric Registry”, with the purpose of collecting data surrounding paediatric CEUS. The primary aim is documenting the technique’s safety in children, and demonstrating the technique’s potential value as an alternative to CT and MR imaging, limiting exposure to radiation and nephrotoxic contrast agents. Data from this registry are herein presented.