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Emerging applications of contrast-enhanced ultrasound in pediatric imaging

March 19, 2019
Pediatrics Ultrasound
From the March 2019 issue of HealthCare Business News magazine

By Ryne A. Didier and Anush Sridharan

Pediatric imaging comes with unique challenges, including unpredictable patient cooperation, varying child size and wide breadth of pathology.

As parents continue to rightfully advocate for their child, concerns regarding invasive procedures, radiation exposure and sedation risks often arise in conversations with clinicians and radiologists. Therefore, being able to obtain diagnostic information using noninvasive technologies with minimal risks is an important and appealing area of shared interest for researchers, clinicians and families.

Ultrasonography (or ultrasound), which uses high-frequency sound waves transmitted through the body to generate images, offers a noninvasive, radiation-free and cost-effective imaging modality. By providing dynamic, real-time visualization of the internal organs and structures, ultrasound (US) affords additional benefits when compared to other diagnostic imaging modalities. However, limitations of US include operator dependence and challenges associated with the patient’s body habitus and scanning characteristics. Furthermore, US employs the Doppler principle to specifically study vascular structures and perfusion defects, but this technique is most sensitive in organs with relatively high blood flow and larger vessels. The discovery and development of US contrast agents has paved the way to overcome some of these limitations and augment diagnostic examinations.

Commonly used US contrast agents consist of gas-filled microbubbles encapsulated by a lipid shell. Their size, typically 1 to 8 microns in diameter, makes them purely intravascular agents that do not diffuse into the interstitial or intracellular space. Contrast-enhanced US (CEUS) relies on the physical interactions between the transmitted US waves and these microbubbles to provide optimal visualization. Administration of the contrast agent can be into the patient’s veins (intravascular) or into a specific cavity (intraluminal/intracavitary). Visualization of the contrast agent is short-lived, on the order of minutes, due to damage by shear forces and instability of the lipid shell. The gas released when the microbubble is destroyed is ultimately expelled by the patient’s lungs. The US contrast agents currently available for medical use in the U.S. have excellent safety profiles and do not cause renal toxicity, which is in contradistinction to the iodine- or gadolinium-based media used in computed tomography (CT) and magnetic resonance (MR) imaging. Advancements in US system software now allow excellent spatial and temporal resolution for real-time CEUS evaluation. These advantages are attractive to pediatric imagers and CEUS has emerged as an incredibly valuable imaging technique.

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