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Echo-enhanced color Doppler sonography in children and adolescents
M Riccabona1, M Uggowitzer, E Klein
1Department of Radiology, University Hospital LKH Graz, Austria.
Insights
Echo-enhanced color Doppler sonography significantly improves diagnostic accuracy for pediatric vascular conditions compared to standard color Doppler sonography. This nonionizing imaging tool enhances visualization of pathology, aiding in diagnosis and follow-up.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Vascular Ultrasound
Background:
- Assessing diagnostic value of echo-enhanced color Doppler sonography (ECDCS) in pediatric patients.
- Evaluating various pathologic conditions including tumors, vascular disorders, and parenchymal lesions.
- Utilizing Levovist (SHU 508A) as an echo-enhancing contrast agent approved for pediatric use.
Purpose of the Study:
- To prospectively assess the diagnostic value of ECDCS in pediatric and adolescent populations.
- To compare the accuracy of ECDCS with standard color Doppler sonography (CDS).
- To evaluate ECDCS as a nonionizing imaging tool for detecting and following pathologic conditions.
Main Methods:
- Prospective study of 51 pediatric patients with diverse pathologic conditions.
- All patients underwent CDS followed by ECDCS, with diagnoses confirmed by additional imaging or histology.
- A subset of 20 children did not require ECDCS as CDS alone was diagnostic.
Main Results:
- ECDCS enhanced visualization of pathologic conditions in 87.3% of investigations compared to CDS.
- Overall accuracy for ECDCS was 95.2% (sensitivity 95%), significantly higher than CDS at 65.7%.
- No adverse reactions were observed with the contrast material; three specific lesions were missed.
Conclusions:
- ECDCS is beneficial in pediatric sonography, improving visualization of vessels and perfusion.
- It serves as a valuable nonionizing tool for specific cases requiring enhanced imaging of vascular pathology.
- ECDCS showed no significant advantage over CDS for infants or superficial lesions.
Abstract:
Fifty-one patients, with a range of underlying pathologic conditions, were studied prospectively to assess the diagnostic value of echo-enhanced color Doppler sonography in the pediatric and adolescent population Their diagnoses included various tumors, vascular disorders, cerebral bleeding, pathologic conditions of small parts, and focal lesions of parenchymal organs. All patients underwent color Doppler sonography before proceeding to echo-enhanced color Doppler sonography. Diagnoses were confirmed by additional imaging (computed tomography, magnetic resonance imaging, angiography, and scintigraphy) performed as appropriate, with or without histologic study. An additional 20 children did not proceed to echoenhanced color Doppler sonography as color Doppler sonography alone was found to be sufficiently diagnostic. Levovist (SHU 508A), a contrast agent based on galactose-encapsulated air microbubbles, is approved for pediatric applications in Austria and was used as the echo-enhancing agent. Echo-enhanced color Doppler sonography was performed a total of 63 times in 51 patients (mean age, 9.8 years). Compared to color Doppler sonography, echo-enhanced color Doppler sonography either detected or enhanced visualization of pathologic conditions in 55 investigations (87.3%), yielding an overall accuracy of 95.2% (sensitivity, 95%), versus 65.7% with color Doppler sonography. One spinal arteriovenous malformation, one cerebral cavernoma, and one liver lesion were missed. The contrast material was easy to administer; no adverse reactions were observed. We conclude that echoenhanced color Doppler sonography is beneficial in pediatric sonography. It enhances visualization of vessels and perfusion, thus offering a nonionizing imaging tool for detection and follow-up evaluation of pathologic conditions with disturbed vasculature in specific cases. In infants and in persons with superficial lesions it did not offer significant advantages over color Doppler sonography.