Contrast-enhanced ultrasound: ready for prime time in paediatric imaging?

Ultrasound represents the first imaging step in the assessment of the paediatric patient. Ultrasound is well-tolerated by children, safe, with no contraindication, but above all involving no ionising radiation. With a suitable body habitus, ultrasound is well-suited in children to examine virtually any part of the body, with better imaging quality than in the adult, […]Ultrasound represents the first imaging step in the assessment of the paediatric patient. Ultrasound is well-tolerated by children, safe, with no contraindication, but above all involving no ionising radiation. With a suitable body habitus, ultrasound is well-suited in children to examine virtually any part of the body, with better imaging quality than in the adult, particularly the abdomen. Crucially, the ability of ultrasound is often questioned: does it provide enough information in all scenarios? This really is dependent on the clinical enquiry. Ultrasound is sufficient to characterise neck lymphadenitis in child with a virus infection, can usually accurately detect appendicitis or can readily detect intraabdominal fluid during a FAST examination. However, ultrasound alone may not be sufficiently robust to accurately depict a hepatic laceration from handle-bar injury, or to characterise a focal liver lesion (FLL) in a child with diffuse liver disease. Often, ultrasound practitioners will rely on CT or MRI to further assess an abnormality, but at further cost. Furthermore, contrast agents used in CT and MRI entail an increased risk for renal impairment and nephrogenic systemic fibrosis both for adults and children. Beyond renal impairment, gadolinium agents are associated with deposition in the brain of patients with normal renal function, raising concern for potential long-term toxicity, mostly worrying for young patients with a longer life expectancy. Child exposure to ionising radiation during CT imaging is a shortcoming, leading to a recognised increased risk for future cancer development. The need for sedation is yet another issue with CT and MRI in paediatric practice, where children may not be able to remain perfectly immobile during a scan.

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