Contrast-enhanced ultrasound for the diagnosis of abdominal solid organ injuries in children

Identification of abdominal solid organ injuries in children relies on the use of computerized tomography (CT) scan, despite its radiation. Although ultrasound has a low diagnostic sensitivity for solid organ injuries, contrast-enhanced ultrasound (CEUS) has high sensitivity in single-center analyses. We conducted a prospective multicenter trial to identify the sensitivity of CEUS in the identification of abdominal solid organ injuries.

Stable patients with an abdominal solid organ injury on CT scan underwent grayscale/Doppler and CEUS within 48 hours. US and CEUS images were interpreted locally and centrally by radiologists blinded to CT results and were compared with their respective CT's.

Sixty-seven patients had 82 organ injuries identified on local CT review, 55 (67.1%) were identified on grayscale/Doppler ultrasound and 67 (81.7%) on CEUS. Nine organ injuries missed by CEUS were wrongly diagnosed in an organ adjacent to a CT-diagnosed organ injury. The remaining six missed organ injuries were grade 1 or 2, two of which were not seen on central CT. The local CEUS positive predictive value (PPV) was 93.0%, negative predictive value (NPV): 94.1%, sensitivity: 81.7%, and specificity: 98.0%. There were no adverse events. Image transmission concerns precluded central review of 10 injuries in 33 organs. Seventy-two organ injuries were identified on central CT, 33 of which were identified on grayscale/Doppler (45.8%) and 56 (77.8%) on CEUS. CEUS missed sixteen organ injuries, 10 of which were adjacent to a CT-identified organ injury. The remaining six missed organ injuries were grade 1 or 2. Central CEUS PPV was 91.8%, NPV: 93.3%, sensitivity: 77.8%, and specificity: 96.9%.

CEUS identifies around 80% of CT-diagnosed abdominal solid organ injuries in this multicenter trial and may be a valuable first imaging study in certain children with potential abdominal solid organ injuries. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).

Level II.