Spectrum, Applicability and Diagnostic Capacity of Contrast-Enhanced Ultrasound in Pediatric Patients and Young Adults after Intravenous Application – A Retrospective Trial

Abstract

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.

Zusammenfassung

Ziel: Untersuchung von Spektrum, Anwendbarkeit und diagnostischen Möglichkeiten bei intravenöser Kontrastmittelsonografie in einem pädiatrischen Kollektiv.

Material und Methoden: Von 08/2005 bis 11/2015 erhielten n = 40 pädiatrische Patienten und junge Erwachsene von 0 – 26 Jahren (Ø 11,4 ± 7,5) mit 3,0 – 85,3 kg (Ø 40,8 ± 25,6) n = 55 Untersuchungen mit n = 79 i. v. Applikationen eines Ultraschallkontrastmittels (KM). KM-Dosis und Nebenwirkungen wurden dokumentiert. Untersucht wurden Leber (n = 42), Milz (n = 9), Niere (n = 3), und Hoden (n = 1). Histologie, Operation oder Referenzbildgebung wurde mit CEUS und dem klinischen Verlauf verglichen.

Ergebnisse: Die KM-Dosis lag für < 20 kg bei 0,4 ± 0,3 ml (0,05 ± 0,02 ml/kg) und für > 20 kg bei 1,0 ± 0,4 ml (p< 0,0001) (0,02 ± 0,01 ml/kg, p< 0,0001). Nebenwirkungen wurden in 2/79 Fällen (2,5 %) beschrieben. Übereinstimmung CEUS/Goldstandard resultierte in 32/34 Untersuchungen. Für Leberdiagnostik (Goldstandard: MRT, CT, Histologie, Serologie) wurden n = 11 maligne und n = 14 benigne fokale Läsionen eingeschlossen. Die Spezifität betrug 100 % (95 % CI: 0,77 – 1,00), die Sensitivität 82 % (95 % CI: 0,48 – 0,98), der positive prädiktive Wert 100 % (95 % CI: 0,69 – 1,00) und der negative prädiktive Wert 88 % (95 % CI: 0,62 – 0,98, p< 0,0001). In n = 2 lag die Referenzmethode falsch und CEUS zeigte eine Übereinstimmung mit dem klinischen Verlauf. Alle Milz-/Nierenläsionen wurden korrekt diagnostiziert, in n = 1 konnte eine unzureichende testikuläre Perfusion ausgeschlossen werden. Der Beobachtungszeitraum für den klinischen Verlauf waren 30,4 ± 30,5 Monate.

Schlussfolgerung: CEUS ist eine gut verträgliche und diagnostisch gleichwertige Modalität bei pädiatrischen Patienten, die fundamentale Vorteile im Gegensatz zu etablierten Methoden für die Altersklassen bietet.

Key words

CEUS - pediatric - off-label - contrast agents

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