ICUS Weekly News Monitor 2-2-2017

1.  Diagnostic Imaging,  Feb 1, 2017,  Contrast-enhanced Ultrasound in Children
 
2.  American Journal of Roentgenology,  Feb, 1, 2017,  Retrospective Analysis of the Safety and Cost Implications of Pediatric Contrast-Enhanced Ultrasound at a Single Center     Authors: Gibran T. Yusuf, et al
 
3.  Medscape - Heartwire,  Jan 12, 2017,  FDA Removes Shunt Contraindication From Lumason Label     By Larry Hand
 
4.  Central European Journal of Urology,  Nov 30, 2016,  Contrast enhanced ultrasound in urothelial carcinoma of urinary bladder: An underutilized staging and grading modality.     Authors:  Gupta VG, et al
 
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Diagnostic Imaging
Feb 1, 2017
 
Contrast-enhanced Ultrasound in Children
 
Pediatric contrast-enhanced ultrasound (CEUS) is a safe procedure and allows for less ionizing radiation and gadolinium contrast administration, according to a study in the American Journal of Roentgenology.
 
Researchers from the United Kingdom analyzed adverse incidents encountered in pediatric CEUS, and sought to determine if there were financial benefits to reducing the number of CT and MRI examinations among children.
 
The researchers analyzed all CEUS examinations performed on children aged 18 and younger between January 2008 and December 2015. The children received a median dose of 2.4 mL of a sulfur hexafluoride microbubble contrast agent, with ranges from 0.1 mL to 4.8 mL. All immediate reactions deemed due to contrast examinations were documented in radiology reports. Electronic patient records were examined for adverse reactions within 24 hours not due to an underlying pathologic condition. Costs were also compared: CEUS utilization cost at $94, CT at $168, and MRI at $274.
 
The results showed that of 187 boys and 118 girls (305 children total), 147 studies (48.2%) were ordered to characterize liver lesions and 113 studies (37.1%) for trauma. The remaining 45 studies (14.8%) were for renal, vascular, and intracavitary assessment. There were no immediate adverse reactions and delayed adverse reactions occurred in two patients (0.7%): transient hypertension and transient tachycardia. Neither was symptomatic, and both were deemed not due to the underlying disorder. The potential cost savings of CEUS was $74 per examination over CT and $180 over MRI.
 
The researchers concluded that the use of pediatric CEUS is safe and potentially cost-effective. Using CEUS in this population allows reduction in the ionizing radiation associated with CT and in the gadolinium contrast administration, sedation, and anesthesia sometimes required for MRI.
 
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American Journal of Roentgenology
Volume 208, Number 2
Feb, 1, 2017
 
Retrospective Analysis of the Safety and Cost Implications of Pediatric Contrast-Enhanced Ultrasound at a Single Center
Authors: Gibran T. Yusuf1, Maria E. Sellars1, Annamaria Deganello1, David O. Cosgrove1 and Paul S. Sidhu1
 
Affiliation: 1Department of Radiology, King's College London, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
Citation: American Journal of Roentgenology. 2017;208: 446-452. 10.2214/AJR.16.16700
 
ABSTRACT :
OBJECTIVE. Because of concern over medical ionizing radiation exposure of children, contrast-enhanced ultrasound (CEUS) has generated interest as an inexpensive, ionizing radiation–free alternative to CT and MRI. CEUS has received approval for pediatric hepatic use but remains off-label for a range of other applications. The purposes of this study were to retrospectively analyze adverse incidents encountered in pediatric CEUS and to assess the financial benefits of reducing the number of CT and MRI examinations performed.
 
MATERIALS AND METHODS. All pediatric (patients 18 years and younger) CEUS examinations performed between January 2008 and December 2015 were reviewed. All immediate reactions deemed due to contrast examinations were documented in radiology reports. Electronic patient records were examined for adverse reactions within 24 hours not due to an underlying pathologic condition. With tariffs from the U.K. National Institute of Clinical Excellence analysis, CEUS utilization cost ($94) was compared with the CT ($168) and MRI ($274) costs of the conventional imaging pathway.
 
RESULTS. The records of 305 pediatric patients (187 boys, 118 girls; age range, 1 month–18 years) undergoing CEUS were reviewed. Most of the studies were for characterizing liver lesions (147/305 [48.2%]) and trauma (113/305 [37.1%]); the others were for renal, vascular, and intracavitary assessment (45/305 [14.8%]). No immediate adverse reactions occurred. Delayed adverse reactions occurred in two patients (2/305 [0.7%]). These reactions were transient hypertension and transient tachycardia. Neither was symptomatic, and both were deemed not due to the underlying disorder. The potential cost savings of CEUS were $74 per examination over CT and $180 over MRI.
 
CONCLUSION. Pediatric CEUS is a safe and potentially cost-effective imaging modality. Using it allows reduction in the ionizing radiation associated with CT and in the gadolinium contrast administration, sedation, and anesthesia sometimes required for MRI.
 
Read More: http://www.ajronline.org/doi/abs/10.2214/AJR.16.16700
 
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Medscape - Heartwire
January 12, 2017
 
FDA Removes Shunt Contraindication From Lumason Label
By Larry Hand
 
Bracco Diagnostics has announced that the Food and Drug Administration has removed from the label of Lumason the contraindication that it should not be used in patients with known or suspected right-to-left, bidirectional, or transient right-to-left cardiac shunts.
 
The FDA posted the new label for Lumason (sulfur hexafluoride lipid-type A microspheres) on its website December 22, 2016.
 
The new label maintains a specific warning that some intravenously injected microspheres could bypass the filtering by the lung and enter the arterial circulation and that Lumason should not be administered by intra-arterial injection.
 
"The removal of this contraindication implies that the FDA has determined that the benefits from the diagnostic information that could be obtained through the use of Lumason in patients with cardiac shunts may outweigh the risk for systemic embolization," Dr Alberto Spinazzi (Global Medical and Regulatory Affairs, Bracco Group) stated in the release.
 
Lumason, an ultrasound contrast agent made up of gas-filled microspheres to enhance echogenicity of blood or urine, was initially approved by the FDA in 2014 for use in adults with suboptimal echocardiograms. Known globally as Sonavue, it gained additional approval in 2016 for use in ultrasonography of the liver in adult and pediatric patients and for use in the evaluation of suspected or known vesicoureteral reflux in pediatric patients.
 
The Centers for Medicare and Medicaid Services granted "pass-through" status in 2015 for reimbursement of Lumason in liver or abdominal ultrasound with contrast.
 
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Central European Journal of Urology
Cent European J Urol. 2016;69(4):360-365.
doi: 10.5173/ceju.2016.893. Epub 2016 Nov 30
Nov 30, 2017.
 
Contrast enhanced ultrasound in urothelial carcinoma of urinary bladder: An underutilized staging and grading modality.
Authors:  Gupta VG1, Kumar S2, Singh SK1, Lal A3, Kakkar N4.
 
1Post Graduate Institute of Medical Education and Research, Chandigarh, India.
2Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
3Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
4Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
 
Abstract
 
INTRODUCTION:
To evaluate contrast enhanced ultrasound (CEUS) as a modality to predict T stage of cancer of urinary bladder (CAUB) and to predict the grade of the tumor preoperatively.
MATERIAL AND METHODS:
110 patients with CAUB presenting to the Department of Urology at our institution between July 2014 and December 2015 underwent CEUS prior to endoscopic resection and the CEUS findings were compared with histopathology results.
RESULTS:
CEUS had a sensitivity of 75, 65 and 90% and specificity of 95, 85 and 92% in detecting Ta, T1 and muscle invasion respectively. CEUS had a sensitivity of 78% and specificity of 85% in detecting the grade of the lesion.
CONCLUSIONS:
CEUS is a good alternative for T staging and grading of CAUB preoperatively. It is uniquely advantageous in detecting clots or necrosis and in patients with low eGFR where other imaging modalities are contraindicated.

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