Contrast-enhanced sonography a ‘sound’ alternative in pediatric advanced imaging

Off-label use of contrast-enhanced ultrasound (CEUS) may be the best advanced-imaging choice—safe, accurate and cost-effective as compared to guideline-recommended CT and MRI—for examining children in many instances, according to a British study published online Dec. 13 in the American Journal of Roentgenology.

Gibran Yusuf, MBBS, and colleagues at King’s College Hospital in London concluded as much after reviewing the medical records of all pediatric patients who were imaged with CEUS at their institution between January 2008 and December 2015.

In total, they looked at 305 cases (187 boys, 118 girls; age range, 1 month to 18 years).

Most of the exams were for characterizing liver lesions (48.2 percent) and trauma (37.1 percent); the others were for renal, vascular and intracavitary assessment (14.8 percent).

None of the patients had immediate adverse reactions, the authors report.

Only two (0.7 percent) had delayed adverse reactions (0.7 percent), and both were asymptomatic and transient (hypertension and tachycardia).

The potential cost savings of CEUS were $74 per exam over CT and $180 over MRI, the authors calculate.

In their discussion, Yusuf et al. note that, in adults, CEUS has sensitivity and specificity comparable to that of CT and MRI.

They point out that CEUS can be safer than CT, as CEUS doesn’t involve ionizing radiation, and safer than MRI, as it almost never requires sedation or anesthesia, much less gadolinium-based contrast administration.

CEUS is generally the most cost-effective of the three advanced-imaging modalities—and the authors found the modality saved their institution almost $16,000 versus what the tab would have been had MRI and CT been used where indicated per institutional norms.

The authors caution that, while CEUS is safe, the use of any contrast calls for vigilance during and after administration.

They also acknowledge the imperfect diagnostic accuracy of CEUS.

“Correlating modalities were often performed before the CEUS examination; simultaneous cross-sectional diagnostic imaging was not performed for confirmatory purposes,” they write. “Patients undergoing sonographic examination were referred for further imaging if there was any doubt in the diagnosis, but there remains the possibility of misdiagnosis, as with all methods of imaging.”