Figure - available from: European Journal of Pediatrics
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Liver telangiectasias in a 6-year-old female presented with confirmed hereditary hemorrhagic telangiectasia syndrome. a Multiple hyperenhancing lesions (arrows on left transverse CEUS image) with avid enhancement during the early arterial phase. Note that the lesions are not as clearly visible on the corresponding grayscale US image (right). b CEUS image in the portal venous phase, lesions are hyper to isoechoic compared to liver parenchyma. c CEUS image in the delayed phase, the lesions are now isoechoic relative to the liver parenchyma and no longer visible. d Many enhancing liver telangiectasias (arrows) visible on coronal CT with contrast during early arterial phase
Source publication
Contrast-enhanced ultrasound (CEUS) is a versatile imaging modality that improves the diagnostic potential of conventional ultrasound. It allows for portable imaging at the bedside. In this paper, we illustrate how CEUS can be used in evaluating several focal lesions in the pediatric population, including liver hemangioma, telangiectasias, splenic...
Citations
... CEUS is also helpful for post-treatment follow-up. Also, a strong correlation exists between ultrasound quantitative patterns, neoplasm size, and local invasion [17]. One study shows that a high peak in the arterial phase is associated with vascular tumors, whereas early washout has a strong association with malignancy [15]. ...
Contrast-enhanced ultrasound (CEUS) is a relatively new approach for the definitive diagnosis of focal liver lesions (FLL). The essential advantages of CEUS are affordability, absence of radiation, and negligible nephrotoxicity-making this diagnostic approach more preferable.
This review includes data from 39 different research studies published during the last 10 years, selected through the MeSH strategy in PubMed.
We conclude that CEUS is a promising approach for diagnosing primary liver neoplasms and it is an excellent radiological approach for children and pregnant women because of the absence of radiation and nephrotoxicity. Studies showed that CEUS is a very good approach for the differentiation of a variety of hemangiomas and for a detailed description of those findings. Therefore, CEUS is an important and progressive method for the diagnosis of liver neoplasms. The regular use of CEUS will facilitate the diagnosis of primary liver lesions.
... Moreover, UCAs have been proven to be safer than MRI contrast agents (the risk of an anaphylactic reaction is 1:10,000, with few adverse events, and no serious adverse events have been reported) [21,22] . The European Federation of Societies for Ultrasound in Medicine and Biology in 2017 stated that UCAs have a good safety profile in adults, and the data in children suggest they are as safe for use in the paediatric population [23] . UCAs are also cheaper than MRI or CT. ...
Radiological assessment is evolving rapidly, including in paediatric liver tumour surgery. There are advancements in the fields of conventional radiology, 3D imaging and preoperative planning. This article presents the current research in paediatric liver imaging for liver tumour surgery and shows the results of a systematic search in computer-aided liver surgery in children. Sixteen original papers were found. We summarise the progress made and offer the directions in which further research could go. Computer-assisted surgery is a promising field for research and clinical application.
Objective
To evaluate if ultrasound during urodynamics (uUS) will show that traditional ultrasound (tUS) routinely underestimates the potential magnitude of upper tract dilation (UTD).
Methods
Prospective pilot study of 10 consecutive patients ≥ 5 years of age undergoing same day uUS and tUS. Using randomized images the study pediatric radiologist determined anterior-posterior renal pelvic diameter (APD), bladder volume, vesicoureteral reflux (VUR) and UTD grades. A single pediatric urologist determined urodynamic bladder capacity and assigned either hostile, intermediate, abnormal but safe, or normal national spina bifida patient registry classification (NSBPR).
Results
Bladder volume on tUS was significantly smaller than final bladder volume on uUS (180 vs 363 ml: p<0.001). On average, patient reported maximum catheterized/voided volumes were also 82 ml greater than final bladder capacity on uUS. UTD was upgraded in 25% of kidneys and APD increased by 0.6 cm on uUS over that seen on tUS (p=0.001). Units with VUR had greater increases in APD (1.2 p=0.007 vs. 0.3 cm p=0.06). Changes in APD stratified by NSBPR revealed average increases of up to 1.3 cm.
Conclusion
Despite instructions to the contrary, patients come for tUS with a relatively empty bladder as compared to either their urodynamic or patient-reported capacity. This translates to a significant underestimation of UTD with tUS, most notably in those with VUR. Alternatives to traditional protocols include insisting patients wait until their bladder is truly full for tUS, retrograde filling their bladder, or performing uUS. Accurate assessment of UTD severity may help guide long term management.
Ultrasound has become a useful tool in the workup of pediatric patients abstract because of the highly convenient, cost-effective, and safe nature of the examination. With rapid advancements in anatomic and functional ultrasound techniques over the recent years, the diagnostic and interventional utility of ultrasound has risen tremendously. Advanced ultrasound techniques constitute a suite of new technologies that employ microbubbles to provide contrast and enhance flow visualization, elastography to measure tissue stiffness, ultrafast Doppler to deliver high spatiotemporal resolution of flow, three- and four-dimensional technique to generate accurate spatiotemporal representation of anatomy, and high-frequency imaging to delineate anatomic structures at a resolution down to 30 mm. Application of these techniques can enhance the diagnosis of organ injury, viable tumor, and vascular pathologies at bedside. This has significant clinical implications in pediatric patients who are not easy candidates for lengthy MRI or radiation-requiring examination, and are also in need of a highly sensitive bedside technique for therapeutic guidance. To best use the currently available, advanced ultrasound techniques for pediatric patients, it is necessary to understand the diagnostic utility of each technique. In this review, we will educate the readers of emerging ultrasound techniques and their respective clinical applications. Copyright © 2019 by the American Academy of Pediatrics. All rights reserved.
The purpose of our study was to measure the radiation dose from ECG-gated CT coronary angiography in children and to estimate the cancer risk associated with the radiation dose.
Organ doses were measured with a 5-year-old pediatric phantom and thermoluminescent dosimeters on a 64-MDCT scanner. Four retrospectively ECG-gated CT coronary angiography protocols with four simulated heart rates and the corresponding pitches were studied. The lifetime attributable risk of cancer incidence was estimated for children in the United States and Hong Kong according to the National Academies Biologic Effects of Ionizing Radiation VII report.
The effective doses were 16.45, 12.17, 11.97, and 11.81 mSv for the four protocols, respectively. The corresponding lifetime attributable risks estimated for 5-year-old U.S. boys and girls were 0.14%-0.20% and 0.43%-0.60%, respectively, and for 5-year-old Hong Kong boys and girls were 0.22%-0.33% and 0.61%-0.85%. In relation to the total cancer incidence (baseline cancer incidence plus lifetime attributable risk), lifetime attributable risk from radiation exposure contributed up to 0.99% and 3.51% for Hong Kong boys and girls and up to 0.46% and 1.57% for U.S. boys and girls.
Our results suggest that radiation dose and cancer risk of CT coronary angiography to pediatric patients are not negligible, more so in Hong Kong children than in U.S. children. Therefore, these examinations should be well justified clinically.
