This book is a comprehensive guide to the rapidly evolving field of contrast-enhanced ultrasound (CEUS) in the child. The uses and interpretation of CEUS are clearly explained with the aid of numerous illustrations. The coverage encompasses both established indications, such as focal liver lesions, abdominal solid organ injury, and vesicoureteral reflux, and a range of newer applications. Extensive information is also provided on microbubble agents and their use in the pediatric age group, as well as on practical aspects of setting up a CEUS service for children.
CEUS is a safe imaging method that is ideal for the young patient and can be used for problem solving in a number of clinical situations. Ultrasound combined with microbubble contrast avoids the ionizing radiation of a CT examination, the use of iodinated contrast, the need for sedation or a general anesthetic, and the complexities of MR imaging. In bringing readers up to date with best practice and the latest innovations in CEUS, this book will be of value for pediatric radiologists, pediatric sonographers/technicians, and pediatricians.
Author(s): Paul S. Sidhu, Maria E. Sellars, Annamaria Deganello
Publisher: Springer
Year: 2020
Language: English
Pages: 275
City: Cham
Foreword
Preface
Contents
About the Editors
1: Physics of Microbubble Contrast Agents
1.1 Introduction
1.2 Microbubble Contrast Agents
1.2.1 Efficacy of Microbubbles as Contrast Agents
1.2.2 Composition of Microbubble Contrast Agents
1.2.2.1 Core
1.2.2.2 Shell Types
1.2.2.3 Size
1.2.3 Microbubble Behavior in Acoustic Fields
1.2.3.1 Linear Response
1.2.3.2 Nonlinear Response
1.2.3.3 Microbubble Destruction
1.2.4 Models of Microbubble Dynamics
1.3 Ultrasound Imaging with Contrast
1.3.1 Ultrasound Imaging
1.3.2 Mechanical Index (MI)
1.3.3 Contrast-Enhanced Ultrasound Imaging (CEUS)
1.3.3.1 Fundamental B-Mode Imaging
1.3.3.2 Harmonic B-Mode Imaging
1.3.3.3 Harmonic Power Doppler
1.3.3.4 Multi-Pulse Contrast-Enhanced Imaging
Pulse Inversion (PI)
Amplitude Modulation (AM)
Alternative Multi-Pulse Sequences
1.3.3.5 Super- and Sub-Harmonic Imaging
1.3.3.6 Potential Harmonic Imaging Artifacts
1.4 Summary
References
2: Safety of Contrast-Enhanced Ultrasound
2.1 Introduction
2.2 Biophysics and Bio-effects
2.3 Safety of CEUS in Pediatrics: Clinical Evidence
2.4 Recommendations for Ensuring Safe Use of UCAs in Pediatric Patients
References
3: Quantitative Contrast-Enhanced Ultrasound
3.1 Introduction
3.2 Requirements for Quantification of CEUS Data
3.3 Options for Quantification of CEUS Exams
3.3.1 Time Intensity Curves
3.3.2 Replenishment Kinetics
3.3.3 Quantitative CEUS in Children
3.4 Summary
References
4: Artifacts in Contrast-Enhanced Ultrasound Examinations
4.1 Introduction
4.2 Ultrasound Contrast Agents
4.3 Artifacts Associated with High Mechanical Index Imaging
4.3.1 Blooming Artifact
4.3.2 Effects on the Spectral Doppler
4.3.2.1 Pseudo-Increase in Systolic Peak Velocity
4.3.2.2 High-Intensity Transient Signals: “Spikes”
4.3.2.3 Clutter
4.3.2.4 Simulated Acoustic Emission
4.4 Artifacts Associated with Low Mechanical Index Imaging
4.4.1 B-Mode Ultrasound Artifacts on CEUS
4.4.1.1 Posterior Acoustic Enhancement
4.4.1.2 Acoustic Shadowing
4.4.1.3 Mirror Image
4.4.2 Artifacts Associated Solely with CEUS
4.4.2.1 Non-linear Artifacts
4.4.2.2 Pseudo-Enhancement
4.4.2.3 Signal Saturation
4.4.2.4 Shadowing
4.4.2.5 Near-Field Signal Loss
4.4.2.6 Image Plane Signal Loss
4.5 Conclusion
References
5: How to Perform an Intravenous Contrast-Enhanced Ultrasound (CEUS) Examination in a Child. Methodology and Technical Considerations
5.1 Introduction
5.2 Study Planning
5.3 Technical Considerations
5.4 Intravenous Cannulation
5.5 Ultrasound Contrast Agents and Safety
5.6 Ultrasound Contrast Agents and Dosage
5.7 B-Mode Examination
5.8 CEUS Examination
5.9 Documentation and Reporting
5.10 Conclusion
References
6: How to Set Up a Contrast-Enhanced Ultrasound Service for Children
6.1 Introduction
6.2 Local Approval Procedures
6.2.1 Regulatory Considerations, Off-Label Use and Safety
6.2.2 Pharmacy, Ordering and Stock
6.3 Clinical Service Management and Business Case
6.4 Clinical “Buy-In”
6.5 Learning and Development
6.6 Summary
References
7: Pediatric Focal Lesions in the Liver: A Clinical Perspective
7.1 Introduction
7.2 Benign Liver Lesions
7.2.1 Focal Nodular Hyperplasia
7.2.2 Hepatocellular Adenoma
7.2.3 Hemangioma (Infantile and Congenital)
7.2.4 Liver Cysts
7.2.5 Infective Cysts
7.3 Biliary Cysts
7.4 Mesenchymal Hamartoma
7.4.1 Inflammatory Myofibroblastic Pseudotumor
7.4.2 Calcified Lesions
7.5 Malignant Liver Lesions
7.5.1 Hepatoblastoma
7.5.2 Hepatocellular Carcinoma
7.5.3 Fibrolamellar Tumors
7.5.4 Transitional Tumors
7.5.5 Embryonal Sarcoma
7.5.6 Biliary Rhabdomyosarcoma
7.5.7 Angiosarcoma
7.6 Conclusion
References
8: Contrast-Enhanced Ultrasound of Pediatric Focal Liver Lesions
8.1 Introduction
8.2 Technical Aspects for Liver CEUS Imaging
8.3 Focal Liver Lesions
8.4 Benign Focal Liver Lesions
8.4.1 Focal Fatty Infiltration and Focal Fatty Sparing
8.4.2 Hemangioma
8.4.3 Focal Nodular Hyperplasia
8.4.4 Hepatic Adenoma
8.4.5 Cystic Lesions
8.4.6 Hepatic Abscess
8.4.7 Regenerative Nodular Hyperplasia
8.4.8 Mesenchymal Hamartoma of the Liver
8.4.9 Bile Duct Hamartomas (von Meyenburg Complex) and Bile Duct Adenomas
8.5 Malignant Focal Liver Lesions
8.5.1 Hepatoblastoma
8.5.2 Hepatocellular Carcinoma
8.5.3 Undifferentiated Embryonal Sarcoma
8.5.4 Rhabdomyosarcoma
8.5.5 Hepatic Lymphoma
8.5.6 Hepatic Metastasis
8.6 Conclusion
References
9: Pediatric Contrast-Enhanced Ultrasonography (CEUS): Pediatric Transplantation
9.1 Introduction
9.2 Liver Transplantation
9.2.1 Biliary and other nonvascular complications
9.3 Kidney transplanation
9.4 Special indications and so on
9.4.1 Intra-Cavity CEUS
9.5 Gastrointestinal Graft Versus Host Disease (GvHD) After Stem Cell Transplantation
9.6 Post-Transplant Lymphoproliferative Disease (PTLD)
References
10: Blunt Abdominal Trauma in Children: Clinical Perspective
10.1 Introduction
10.2 Incidence
10.3 Etiology and Patterns of Injury
10.4 Staging and Grading of Traumatic Injuries
10.5 Assessment and Damage Control Resuscitation
10.5.1 Immediate Clinical
10.5.2 Investigations
10.5.3 Radiological Imaging
10.5.4 FAST Scan
10.5.5 Clinical Management
10.6 Splenic Trauma
10.7 Liver Trauma
10.8 Pancreatic Trauma
10.9 Renal Trauma
10.10 Summary CEUS in Abdominal Trauma
References
11: Contrast-Enhanced Ultrasound in Blunt Abdominal Trauma
11.1 Introduction
11.2 Guidelines and Recommendations
11.3 Ultrasound Contrast Administration
11.4 Imaging Techniques: Indications and Limitations
11.4.1 Computed Tomography and Magnetic Resonance Imaging
11.4.2 Conventional Ultrasound Imaging
11.4.3 Contrast-Enhanced Ultrasound
11.5 Traumatic Solid Organ Injuries
11.5.1 Enhancement Patterns of Contrast-Enhanced Ultrasound
11.5.1.1 Parenchymal Lesions: Lacerations, Hematoma, and Capsule Rupture
11.5.1.2 Active Bleeding
11.6 Conclusion
References
12: Contrast-Enhanced Ultrasound of the Pediatric Kidneys
12.1 Introduction
12.2 Safety and Technical Considerations
12.3 Imaging
12.4 Focal Renal Lesions
12.4.1 Bosniak Classification of Renal Cysts
12.5 Renal Angiomyolipoma
12.6 Renal Parenchyma Defects
12.7 Focal Pyelonephritis and Abscess Formation
12.8 Pseudotumors
12.9 Malignant Renal Lesions
12.10 Summary
References
13: Pediatric Contrast-Enhanced Ultrasonography (CEUS) of the Spleen
13.1 Introduction
13.2 Investigation Technique
13.3 Spenunculi or Accessory Spleens, Splenosis, and Polysplenia
13.4 Anomalies of Position: Wandering Spleen
13.5 Splenic Infarction
13.6 Focal and Diffuse Lesions of the Spleen
13.6.1 Benign Focal Lesions of the Spleen
13.6.1.1 Cystic Lesions
13.6.1.2 Hemangioma
13.6.1.3 Lymphangioma
13.6.1.4 Hamartoma
13.6.1.5 Malignant Solid Lesions
Metastasis
Lymphoma
13.6.1.6 Splenic Abscesses
13.6.1.7 Splenic Trauma
13.6.2 Diffuse Lesions of the Spleen
13.7 Conclusion
References
14: Contrast-Enhanced Voiding Urosonography (ceVUS): Current Experience and Advanced Techniques
14.1 Background
14.1.1 Vesicoureteral Reflux
14.1.2 Imaging of Vesicoureteral Reflux
14.1.3 Indications for Reflux Imaging
14.2 How to Perform ceVUS
14.3 Interpretation of ceVUS Imaging Findings
14.3.1 Reflux Grading
14.3.2 Urethra
14.3.3 Diagnostic Comparisons: ceVUS vs VCUG and RNC
14.3.4 Retrograde Urethrography
14.3.5 Complex Genitourinary Anatomy
14.4 Advanced Techniques
14.4.1 3D/4D ceVUS
14.4.2 Intraoperative ceVUS
14.5 Safety
14.6 Conclusion
References
15: Contrast-Enhanced Ultrasound in the Pediatric Scrotum
15.1 Introduction
15.2 Technical Aspects of Pediatric Scrotal US and CEUS
15.3 Clinical Aspects of Pediatric Scrotal Disease
15.4 Conventional US Findings
15.4.1 Torsion of the Spermatic Cord and Appendages
15.4.2 Inflammation and Abscess
15.4.3 Trauma
15.4.4 Tumors and Tumor Mimics
15.5 Potential Roles of CEUS in Pediatric Testis
15.5.1 Spermatic Cord Torsion
15.5.2 Inflammation
15.5.3 Trauma
15.5.4 Tumors
15.6 Conclusion
References
16: Contrast-Enhanced Ultrasound in Childhood Pneumonia
16.1 Introduction
16.2 Clinical Aspects and Definitions of Childhood Pneumonia and Complications
16.3 Imaging of Childhood Pneumonia with US and CT
16.4 Contrast-Enhanced Ultrasound in Childhood Pneumonia
16.4.1 Intravenous CEUS
16.4.2 Intracavitary CEUS
16.5 Conclusion
References
17: Contrast-Enhanced Ultrasound in Inflammatory Bowel Disease
17.1 Introduction and Background
17.2 Dynamic Contrast-Enhanced Ultrasound of Bowel Wall Protocol and Time Intensity Curve Analysis
17.2.1 Patient Preparation
17.2.2 Pre-Acquisition US Examination, US Machine, and UCA Preparation
17.2.3 Acquisition
17.2.4 Post-Processing with Time–Intensity Curve Analysis
17.2.5 Interpretation
17.3 Position Statements for Bowel Dynamic CEUS
17.4 Indications, Advantages, and Limitations of Bowel CEUS
17.4.1 Evaluation of the Disease Activity
17.4.2 Differential Diagnosis Between Fibrotic and Inflammatory Stenosis in Order to Select Patients for Medical Therapy or Surgery
17.4.3 Extraintestinal Complications of Crohn’s Disease
17.4.4 Follow-Up of IBD Patients
17.4.5 Advantages and Limitations
17.4.6 When Is a Bowel CEUS Justified in Pediatrics?
References
18: Contrast-Enhanced Ultrasound in Childhood Oncology
18.1 Introduction
18.2 CEUS of Pediatric Solid Tumors
18.3 Malignant Liver Lesions
18.3.1 Hepatoblastoma
18.3.2 Hepatocellular Carcinoma
18.3.3 Liver Metastases
18.4 Benign Liver Lesions
18.4.1 Hemangioma
18.4.2 Focal Nodular Hyperplasia
18.5 Benign and Malignant Renal Lesions
18.5.1 Complex Renal Cysts
18.5.2 Renal Tumors
18.5.3 Renal Pseudotumor
18.6 CEUS in Pediatric Oncologic Interventions
18.6.1 Biopsy
18.6.2 Tumor Ablation
18.7 Future Directions of CEUS in Oncology
18.8 Conclusions
References
19: Intraoperative Contrast-Enhanced Ultrasound in the Pediatric Neurosurgical Patient
19.1 Introduction
19.1.1 Contrast-Enhanced Ultrasound in Neurosurgery
19.1.2 Contrast-Enhanced Ultrasound: Pediatric Applications in Neurosurgery
19.2 Instruments and Technique
19.2.1 Ultrasound Contrast Agent
19.3 Practical CEUS Applications in Pediatric Neurosurgery
19.3.1 Brain Tumors
19.3.2 Epilepsy Surgery
19.3.3 Chiari Malformation
19.3.4 Moyamoya, Arteriovenous Malformation, and Other Neurovascular Diseases
19.3.5 Intramedullary Tumors
19.3.6 Spinal Dysraphism and Other Spinal Alterations
19.4 Conclusions
References
20: Contrast-Enhanced Ultrasound in Pediatric Intervention
20.1 Principles of Contrast-Enhanced Ultrasound in Pediatric Interventional Radiology
20.2 Technique
20.2.1 Intravascular Administration
20.2.2 Intracavitary Administration
20.3 Applications
20.3.1 Intravascular Applications
20.3.1.1 Biopsy
20.3.1.2 Interventional Oncology
20.3.1.3 Vascular Access
20.3.2 Intracavitary Applications
20.3.2.1 Drainage
20.3.2.2 Sclerotherapy
20.3.2.3 Urinary and Biliary Tracts
20.3.2.4 Other Intracavitary Applications
20.4 Conclusion
References
21: Cost-Effectiveness of CEUS in Pediatric Practice
21.1 Introduction
21.2 Cost Implications
21.3 NICE Guidelines
21.4 Conclusion
References
22: Recent Advances in Neonatal CEUS
22.1 Introduction
22.2 Neonatal Imaging
22.3 Clinical Applications
22.3.1 Hypoxic Ischemic Injury
22.3.2 Brain Death
22.3.3 Intracranial Lesions
22.3.4 Bowel Disease of Prematurity
22.3.5 Developmental Dysplasia of the Hip
22.4 Conclusion and Future Directions
References
