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Contrast enhanced ultrasound for the evaluation of blunt pediatric abdominal trauma
Lindsey B Armstrong1, David P Mooney1, Harriet Paltiel2
1Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, USA.
Insights
Contrast-enhanced ultrasound (CEUS) shows high accuracy in detecting pediatric blunt abdominal trauma injuries, offering a radiation-free alternative to CT scans. This imaging technique significantly improves sensitivity and specificity for identifying organ damage in children.
Area of Science:
- Pediatric radiology
- Diagnostic imaging
- Medical technology
Background:
- Blunt abdominal trauma is common in children.
- Computed tomography (CT) is the standard but involves radiation risks and can yield normal results.
- Contrast-enhanced ultrasound (CEUS) offers a radiation-free imaging alternative.
Purpose of the Study:
- To evaluate the diagnostic performance of CEUS in detecting abdominal solid organ injuries in children with blunt abdominal trauma.
- To compare CEUS with conventional ultrasound and CT for accuracy and effectiveness.
Main Methods:
- Children aged 7-18 with CT-diagnosed injuries underwent conventional ultrasound and CEUS.
- Two blinded radiologists interpreted CEUS images.
- CEUS findings were compared to CT for injury detection and grading.
- Patients were monitored for adverse reactions.
Main Results:
- CEUS demonstrated improved sensitivity (85.7%) and specificity (98.6%) compared to conventional ultrasound.
- Positive predictive value increased to 94.7% and negative predictive value to 95.8% with CEUS.
- No contrast-related adverse reactions were reported; however, two significant injuries were missed by CEUS in the study.
Conclusions:
- CEUS is a promising radiation-free imaging modality for detecting pediatric abdominal solid organ injuries.
- Further multicenter trials are recommended before widespread clinical adoption.
Introduction:
Blunt abdominal trauma is a common problem in children. Computed tomography (CT) is the gold standard for imaging in pediatric blunt abdominal trauma, however up to 50% of CTs are normal and CT carries a risk of radiation-induced cancer. Contrast enhanced ultrasound (CEUS) may allow accurate detection of abdominal organ injuries while eliminating exposure to ionizing radiation.
Methods:
Children aged 7-18years with a CT-diagnosed abdominal solid organ injury underwent grayscale/power Doppler ultrasound (conventional US) and CEUS within 48h of injury. Two blinded radiologists underwent a brief training in CEUS and then interpreted the CEUS images without patient interaction. Conventional US and CEUS images were compared to CT for the presence of injury and, if present, the injury grade. Patients were monitored for contrast-related adverse reactions.
Results:
Twenty one injured organs were identified by CT in eighteen children. Conventional US identified the injuries with a sensitivity of 45.2%, which increased to 85.7% using CEUS. The specificity of conventional US was 96.4% and increased to 98.6% using CEUS. The positive predictive value increased from 79.2% to 94.7% and the negative predictive value from 85.3% to 95.8%. Two patients had injuries that were missed by both radiologists on CEUS. In a 100kg, 17year old female, a grade III liver injury was not seen by either radiologist on CEUS. Her accompanying grade I kidney injury was not seen by one of the radiologist on CEUS. The second patient, a 16year old female, had a grade III splenic injury that was missed by both radiologists on CEUS. She also had an adjacent grade II kidney injury that was seen by both. Injuries, when noted, were graded within 1 grade of CT 33/35 times with CEUS. There were no adverse reactions to the contrast.
Conclusion:
CEUS is a promising imaging modality that can detect most abdominal solid organ injuries in children while eliminating exposure to ionizing radiation. A multicenter trial is warranted before widespread use can be recommended.
Level Of Evidence:
Level II; Diagnostic Prospective Study.
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