Dec 2, 2019 — ICUS
By Kassa Darge, MD
Diagnostic imaging can be a great tool in saving life. However, x-ray, CT and MRI come at a price for children. Radiation, need for sedation or anesthesia and potential serious adverse events of some of the contrast agents are major hurdles to carrying out these studies. No wonder then that there has been such keen interest and remarkable growth in the use of contrast enhanced ultrasound (CEUS), a totally radiation-free, diagnostic imaging modality using safe contrast agents without the need for sedation or anesthesia.
In addition to being safer and radiation-free, CEUS has been shown to produce faster and significantly clearer imaging that allows for more accurate diagnosis, avoiding additional testing and minimizing cost. It is non-invasive allowing the avoidance of biopsies required. Ultrasound contrast agents have been shown to quickly be dispelled from the body, and are approved for children by the FDA. All of this points towards optimum clinical applications in pediatric care.
Originally approved by the FDA for use in echocardiography, other areas such as the liver have been added to the approved list. Off-label usage by practitioners has increased dramatically for many other parts of the body as the benefits of CEUS are increasingly recognized. Outside of the U.S., CEUS has been widely used for decades with great success and for various applications.
At the Center for Pediatric Contrast Ultrasound (CPCU), Founder, and Chair of the Department of Radiology at Children’s Hospital of Philadelphia (CHOP), Kassa Darge said: “CEUS has been used safely for many clinical applications in children for over 20 years, mostly outside the U.S. Here at home, the benefits are being quickly recognized as evidenced in the last few years by the very rapid growth in centers across the country. Before contrast agent approval in 2016 there were just 3 centers doing CEUS in children; now there are more than 40”. The monthly workshops on pediatric contrast ultrasound offered by the CPCU have made a significant contribution to this rapid increase in centers offering the contrast ultrasound service for children. Dr Darge further added “Sedation is not required, studies can also be done at the bedside for critically ill patients, and parents can be in close proximity during their children’s examination. These are additional benefits in children.”
As awareness of the benefits of CEUS have become recognized, so has the need and demand for education and training in its use. The International Contrast Ultrasound Society (ICUS) runs courses throughout the year on the use of CEUS for abdominal and cardiovascular applications, and CHOP has regular courses specifically geared toward pediatric CEUS applications.
CEUS uses liquid suspensions of biocompatible microbubbles that are injected into a patient’s arm vein or administered into a cavity during an ultrasound scan. The microbubbles reflect ultrasound waves as they flow through the body’s microvasculature with red blood cells or move within a cavity, and are expelled from the body within minutes.