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20 CEUS inPediatric Practice
c
349
d
Fig. 20.5 (continued)
350
A. N. Sencha and E. A. Zubareva
a
b
Fig. 20.6 Ovarian torsion. The girl’s age is 3months. (a)
Grayscale US image and CDI. (b) CEUS with SonoVue®,
0.03mL intravenous bolus injection detects no enhance-
ment of the ovary in the arterial phase. (c) The venous
phase CEUS demonstrates the persistence of the perfusion
defect. (d) Quantitative analysis of CEUS with TIC
reveals no enhancement of the ovary
20 CEUS inPediatric Practice
c
351
d
Fig. 20.6 (continued)
352
A. N. Sencha and E. A. Zubareva
renal lesions, post-traumatic changes of internal
organs, in the detection of VUR, but also in the
assessment of transplant disorders, state of the
chest, scrotum, intestine, during intraoperative,
interventional studies, and exhibits prospects in
oncology and neonatal examinations [2].
Considering the lack of ofcial approval for
the use of UCA in children and based on the
obtained experience, we use the following principles in pediatric CEUS:
• The decision to use UCA for indications not
listed in the ofcial instruction (off-label) is
made by the medical board or doctors’
concilium.
• Parents should give a legal written voluntary
informed consent for medical intervention and
the use of UCA for indications not listed in the
instruction (off-label).
• The study is conducted in the presence of the
child’s parent or guardian, an attending physician, and an intensive care unit doctor.
In our practice, we used CEUS in pediatric
patients as an additional imaging method for the
specication of focal lesions, ischemia, and VUR
grade when the results of multiparametric sonography and other imaging methods were
insufcient or conicting.
The advantages of CEUS in pediatric
echography are as follows:
• good tolerability of UCAs
• the ability to assess macro- and
microcirculation of the organ, affected area,
and surrounding structures with high temporal
and spatial resolution, which is beyond the
limits of the conventional US
• the ability to identify tumor perfusion features
is crucial for differential diagnosis
• signicant increase in the diagnostic value of
sonography up to CT and MRI level
• no ionizing radiation, nephrotoxicity, and the
need for sedation [40]
Modern CEUS technologies have many
options to facilitate diagnosis in pediatric practice. Its efcacy prompts further research to
improve the existing methods and provide even
more reliable diagnostic signs.
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