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Contrast ultrasound for pediatrics

por Gus Iversen, Editor in Chief | March 08, 2022
Pediatrics Ultrasound
Dr. Kassa Darge
From the March 2022 issue of HealthCare Business News magazine

In recent years, contrast-enhanced ultrasound (CEUS) has emerged as a promising way to image children for certain indications. Unlike CT, fluoroscopy and nuclear medicine, CEUS is free from radiation and doesn’t require sedation, which is often needed for pediatric patients undergoing MR.

HealthCare Business News checked in with Dr. Kassa Darge, radiologist-in-chief at the Children’s Hospital of Philadelphia department of radiology, to discuss the state of CEUS today.

HCB News: You were an early adopter of contrast enhanced ultrasound (CEUS), can you tell us why you were initially interested in administering these exams?
Dr. Kassa Darge: My interest in CEUS began in the mid ‘90s when I was working in Germany. The initial idea was to try to replace the X-ray voiding cystourethrography with the use of ultrasound contrast agent and ultrasound scan. This meant — particularly 25 years ago — a significant reduction of radiation exposure to young children who are more vulnerable to the damage irradiation causes. I started with exploring the feasibility of using contrast ultrasound and initiated a comparative study with the X-ray voiding cystourethrography. The result was more than we expected. Not only was contrast ultrasound comparable to the X-ray voiding cystourethrography, but it exceeded in terms of detection of vesicoureteric reflux in children. Indeed, on average you found more than 10% of vesicoureteric reflux when using ultrasound with contrast than the fluoroscopic study. This was a great motivation to push for this study, now called contrast enhanced voiding urosonography (ceVUS) in Europe.

HCB News: Can you describe some of the best pediatric use cases for CEUS?
KD: There are a number of excellent pediatric use cases for CEUS. Let me start with the intracavitary administration of ultrasound contrast agent for the detection of vesicoureteric reflux. This not only replaces the X-ray fluoroscopic study voiding cystourethrography (VCUG) but also allows a more comfortable examination for the pediatric patient and a positive family experience. Why comfortable? The child can be in different positions when being scanned. The child can void in physiological positions — either sitting on a potty, preferably one that makes music when peeing is initiated, or in the case of a boy, can stand and pee in a urinal while being scanned from the back. The parents can access their child very closely. They can lie on the examination table with their child or sit close to them and hold them. That the ultrasound modality is diagnostically better than the X-ray one is the icing on the cake. A more sensitive and more comfortable test delivering a positive patient and family experience.

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