Contrast-Enhanced Ultrasound in Children: Implementation and Key Diagnostic Applications

Contrast-enhanced ultrasound (CEUS) utilization is expanding rapidly, particularly in children, in whom the modality offers the important advantages of dynamic evaluation of the vasculature, portability, lack of ionizing radiation, and lack of need for sedation. Accumulating data establish an excellent safety profile of ultrasound contrast agents (UCAs) in children. Although UCAs have been FDA-approved only for IV use in children for characterizing focal liver lesions and for use in children during echocardiography, off-label applications are expanding the diagnostic potential of ultrasound. Focal liver lesion evaluation is the most common use of CEUS, and the American College of Radiology Pediatric LI-RADS Working Group recommends including CEUS for evaluation of a newly discovered focal liver lesion in many circumstances. Data also support the role of CEUS in hemodynamically stable children with blunt abdominal trauma, and CEUS is becoming a potential alternative to CT in this setting. Additional potential applications that require further study include evaluation of pathology in the lung, spleen, brain, pancreas, bowel, kidney, female pelvis, and scrotum. This article explores the implementation of CEUS in children, describing basic principles of UCAs and CEUS technique and summarizing current and potential IV diagnostic applications based on pediatric-specific supporting evidence.