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Contrast enhanced ultrasound in pediatric patients: a real challenge
D G Schreiber-Dietrich1, X W Cui1, F Piscaglia2
1Department of Internal Medicine, Uhlandstr. 7, Caritas-Krankenhaus Bad Mergentheim, 97980 Bad Mergentheim, Germany.
Insights
Contrast-enhanced ultrasound (CEUS) is safe and effective for pediatric patients, despite off-label use challenges. Establishing a registry can improve data collection on ultrasound contrast agents in children.
Area of Science:
- Medical Imaging
- Pediatric Radiology
- Diagnostic Ultrasound
Background:
- Ultrasound (US) imaging is a routine pediatric technique due to its advantages.
- Many drugs and contrast agents lack specific pediatric approval, necessitating off-label use.
- Off-label use of contrast-enhanced ultrasound (CEUS) in children presents legal and diagnostic challenges.
Purpose of the Study:
- To summarize the literature on the utility of CEUS in pediatric patients.
- To highlight the safety and effectiveness of CEUS beyond approved indications.
- To advocate for a registry to collect data on ultrasound contrast agents in children.
Main Methods:
- Literature review of available studies on pediatric CEUS.
- Discussion of legal and diagnostic performance considerations.
- Reference to European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines.
Main Results:
- CEUS is safe and effective for examining various organs in children, not just the liver.
- CEUS demonstrates high diagnostic performance in pediatric clinical routine.
- EFSUMB has highlighted the utility of CEUS in pediatric patients.
Conclusions:
- CEUS is a valuable tool for pediatric imaging, offering safety and efficacy.
- Addressing legal aspects of off-label use is crucial for pediatric CEUS.
- A dedicated pediatric registry is recommended to gather crucial safety and application data for ultrasound contrast agents.
Abstract:
Ultrasound (US) imaging in the paediatric population has been a routine technique for decades, in part because of the advantages it offers over other imaging modalities. Off-label use (and its funding) is of the utmost importance in paediatrics because many drugs have not been evaluated in randomised trials in children. As a consequence such drugs are not specifically approved for use in children. This is also true for the contrast agents used in CEUS. The off-label use of CEUS in paediatric patients illustrates the need to deal with unresolved legal issues while at the same time balancing this with the need for high diagnostic performance in daily clinical routine. In addition to approved indications with a focus on the liver and Doppler enhancement, CEUS is safe and effective for the examination of many organs, as recently highlighted by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). This article provides a summary of the available literature describing the utility of CEUS in paediatric patients. Furthermore, we suggest the establishment of a registry to collect data on safety and applications of ultrasound contrast agents in children. A paediatric registry has recently been introduced by EFSUMB (www.efsumb.org).
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