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Pediatric Radiology
Published in: Pediatric Radiology 12/2012

01-12-2012 | Original Article

Application of a second-generation US contrast agent in infants and children—a European questionnaire-based survey

Author: Michael Riccabona

Published in: Pediatric Radiology | Issue 12/2012

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Abstract

Background

No US contrast agent (US-CA) is currently licensed for use in children.

Objective

To survey the off-label use in children of a second-generation US-CA.

Materials and methods

Questionnaires were e-mailed to European paediatric radiologists, who were asked about their experience with the second-generation US-CA Sonovue® (Bracco, Milan, Italy). Number of examinations per indication and adverse effects were recorded. Examinations were categorised by intravenous or intracavitary use of US-CA.

Results

Out of 146 respondents, 88 stated that they did not perform contrast-enhanced US in children, but 36 of these (44%) would appreciate paediatric approval. Forty-five centres reported 5,079 examinations in children (age mean: 2.9 years; range: birth–18 years, M/F: 1/ 2.8). The majority (4,131 [81%] in 29 centres) were intravesical applications. The minority (948 [19%] in 30 centres) were intravenous applications. No adverse effects had been recorded from intravesical use. Six minor adverse effects (skin reaction, unusual taste, hyperventilation) had been recorded after five intravenous studies (0.52%).

Conclusion

Responses suggest a favourable safety profile of this second-generation US-CA in children. It also demonstrates a demand for such US-CA from paediatric radiologists.
Literature
1.
Ascenti G, Zimbaro G, Mazziotti S et al (2004) Harmonic US imaging of vesicoureteric reflux in children: usefulness of a second generation US contrast agent. Pediatr Radiol 34:481–487PubMedCrossRef
2.
Berrocal T, Gaya F, Arjonilla A et al (2001) Vesicoureteral reflux: diagnosis and grading with echo-enhanced cystosonography versus voiding cystourethrography. Radiology 221:359–365PubMedCrossRef
3.
Bosio M (1998) Cystosonography with echocontrast: a new imaging modality to detect vesicoureteric reflux in children. Pediatr Radiol 28:250–255PubMedCrossRef
4.
Darge K, Dütting T, Zieger B et al (1998) Diagnosis of vesicoureteral reflux with echo-enhanced voiding urosonography. Radiologe 38:405–409PubMedCrossRef
5.
Darge K, Troeger J, Duetting T et al (1999) Reflux in young patients: comparison of voiding US of the bladder and retrovesical space with echo enhancement versus voiding cysto-urethrography for diagnosis. Radiology 210:201–207PubMed
6.
Darge K, Troeger J (2002) Vesicoureteral reflux grading in contrast-enhanced voiding urosonography. Eur J Radiol 43:122–128PubMedCrossRef
7.
Darge K, Beer M, Gordjani N et al (2004) Contrast-enhanced voiding urosonography with the use of a 2nd generation US contrast medium: preliminary results. Pediatr Radiol 34:S97CrossRef
8.
Darge K, Moeller RT, Trusen A et al (2004) Diagnosis of vesicoureteric reflux with low-dose contrast-enhanced harmonic ultrasound imaging. Pediatr Radiol 35:73–78PubMedCrossRef
9.
Darge K (2008) Voiding urosonography with ultrasound contrast agents for the diagnosis of vesicoureteric reflux in children. I. Procedure. Pediatr Radiol 38:40–53PubMedCrossRef
10.
Darge K (2008) Voiding urosonography with US contrast agents for the diagnosis of vesicoureteric reflux in children. II. Comparison with radiological examinations. Pediatr Radiol 38:54–63, quiz 126–127PubMedCrossRef
11.
Darge K (2010) Voiding urosonography with US contrast agent for the diagnosis of vesicoureteric reflux in children: an update. Pediatr Radiol 40:956–962PubMedCrossRef
12.
Kenda RB, Novljan G, Kenig A et al (2000) Echo-enhanced ultrasound voiding cystography in children: a new approach. Pediatr Nephrol 14:297–300PubMedCrossRef
13.
Kmetec A, Bren AF, Kandus A et al (2001) Contrast-enhanced ultrasound voiding cystography as a screening examination for vesicoureteral reflux in the follow-up of renal transplant recipients: a new approach. Nephrol Dial Transplant 16:120–123PubMedCrossRef
14.
Kopitzko A, Cornely D, Reither K et al (2004) Low contrast dose voiding urosonography in children with phase inversion imaging. Eur Radiol 14:2290–2296PubMedCrossRef
15.
McEwing RL, Hellewell S, Anderson NG et al (2002) Comparison of echo-enhanced ultrasound with fluoroscopic MCU for the detection of vesicoureteral reflux in neonates. Pediatr Radiol 32:853–858PubMedCrossRef
16.
Mentzel HJ, Vogt S, Joan U et al (2002) Voiding urosonography with ultrasonography contrast medium in children. Pediatr Nephrol 17:272–276PubMedCrossRef
17.
Papadopoulou F, Anthopoulou A, Siomou E et al (2009) Harmonic voiding urosonography with a second-generation contrast agent for the diagnosis of vesicoureteral reflux. Pediatr Radiol 39:239–244PubMedCrossRef
18.
Piaggio G, Degl’Innocenti ML, Toma P et al (2003) Cystosonography and voiding cysto-urethrography in the diagnosis of vesicoureteral reflux. Pediatr Nephrol 18:18–22PubMedCrossRef
19.
Radmayr C, Klauser A, Pallwein L et al (2002) Contrast enhanced reflux sonography in children: a comparison to standard radiological imaging. J Urol 167:1428–1430PubMedCrossRef
20.
Riccabona M (2002) Cystography in infants and children: a critical appraisal of the many forms with special regard to voiding cystourethrography. Eur Radiol 12:2910–2918PubMed
21.
Riccabona M, Mache CJ, Lindbichler F (2003) Echo-enhanced color Doppler cystosonography of vesicoureteral reflux in children: Improvement by stimulated acoustic emission. Acta Radiol 44:18–23PubMedCrossRef
22.
Valentini AL, Salvaggio E, Manzoni C et al (2001) Contrast enhanced gray-scale and color Doppler voiding urosonography versus voiding cystourethrography in the diagnosis and grading of vesicoureteral reflux. J Clin Ultrasound 29:65–71PubMedCrossRef
23.
Valentini AL, De Gaetano AM, Destito C et al (2002) The accuracy of voiding urosonography in detecting vesico-ureteral reflux: a summary of existing data. Eur J Pediatr 161:380–384PubMedCrossRef
24.
Zimbaro G, Ascenti G, Visalli C et al (2007) Contrast-enhanced ultrasonography (voiding urosonography) of vesicoureteral reflux: state of the art. Radiol Med 112:1211–1224PubMedCrossRef
25.
Riccabona M, Avni FE, Blickman JG et al (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography. Barcelona, Spain, June 2007. Pediatr Radiol 38:138–145PubMedCrossRef
26.
Albrecht T, Blomley M, Bolondi L et al (2004) Guidelines for the use of contrast agents in ultrasound. Ultraschall Med 25:249–256PubMedCrossRef
27.
Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)—update 2008. Ultraschall Med 29:28–44PubMedCrossRef
28.
Piscaglia F, Nolsoe C, Dietrich CF et al (2011) The EFSUMB guidelines and recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 32:1–27CrossRef
29.
Piskunowicz M, Kosiak W, Bratko T (2012) Intravenous application of second-generation ultrasound contrast agents in children: a review of the literature. Ultraschall Med 33:135–140PubMedCrossRef
30.
Correas JM, Bridal L, Lesavre A et al (2001) Ultrasound contrast agents: properties, principles of action, tolerance, and artifacts. Eur Radiol 11:1316–1328PubMedCrossRef
31.
Harvey CJ, Blomley MJK, Eckersley RJ et al (2001) Developments in ultrasound contrast media. Eur Radiol 11:675–689PubMedCrossRef
32.
Quaia E (ed) (2005) Contrast media in ultrasonography: basic principles and clinical applications. Springer, Berlin
33.
34.
Burns PN, Wilson SR, Hope Simpson D (2000) Pulse Inversion Imaging of liver blood flow: an improved method for characterization of focal masses with microbubble contrast. Invest Radiol 35:58–71PubMedCrossRef
35.
Hope Simpson D, Chin CT, Burns PN (1999) Pulse inversion Doppler: a new method for detecting nonlinear echoes from microbubble contrast agents. IEEE Trans Ultrason Ferroelec Freq Contr 46:372–382CrossRef
36.
Lencioni R, Cioni D, Bartolozzi C (2002) Tissue harmonic and contrast specific imaging: back to gray scale in ultrasound. Eur Radiol 12:151–165PubMedCrossRef
37.
Tetsuya K (2002) Technical description of 1.5-harmonic imaging, an effective technique for contrast-enhanced ultrasound diagnosis. Med Rev 87:22–25
38.
Borsboom JM, Chin CT, de Jong N (2003) Nonlinear coded excitation method for ultrasound contrast imaging. Ultrasound Med Biol 29:277–284PubMedCrossRef
39.
Blomley MJK, Albrecht T, Cosgrove DO et al (1998) Stimulated acoustic emission in liver parenchyma with Levovist. Lancet 351:568–569PubMedCrossRef
40.
Whittingham T (2005) Contrast-specific imaging techniques: technical perspective. In: Quaia E (ed) Contrast media in ultrasonography: basic principles and clinical applications. Springer, Berlin, pp 43–70CrossRef
41.
Berry JD, Sidhu PS (2004) Microbubble contrast-enhanced ultrasound in liver transplantation. Eur Radiol 14(Suppl 8):P96–P103PubMed
42.
Bryant T, Blomley MJK, Albrecht T et al (2004) Improved characterization of liver lesions with liver-phase uptake of liver specific microbubbles: prospective multicenter trials. Radiology 232:799–809PubMedCrossRef
43.
Dietrich CF, Kratzer W, Strobe D et al (2006) Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI. World J Gastroenterol 12:1699–1705PubMed
44.
Gasparini C, Bertolotto M, Croce SL et al (2003) Evaluation of liver parenchymal blood flow with contrast-enhanced US: preliminary results in healthy and cirrhotic patients. Acad Radiol 10:869–876PubMedCrossRef
45.
Leen E, Ceccotti P, Kalogeropoulou C et al (2006) Prospective multicenter trial evaluating a novel method of characterizing focal liver lesions using contrast- enhanced sonography. AJR 186:1551–1559PubMedCrossRef
46.
Nicolau C, Catalá V, Vilana R et al (2004) Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiation. Eur Radiol 14:1092–1099PubMedCrossRef
47.
Oldenburg A, Hohmann J, Foert E et al (2005) Detection of hepatic metastases with low MI real time contrast enhanced sonography and SonoVue. Ultraschall Med 26:277–284PubMedCrossRef
48.
Quaia E, D’Onofrio M, Palumbo A et al (2006) Comparison of contrast-enhanced ultrasonography vs baseline ultrasound and contrast-enhanced computed tomography in metastatic disease of the liver: diagnostic performance and confidence. Eur Radiol 16:1599–1609PubMedCrossRef
49.
Quaia E, Bertolotto M, Calderan L et al (2003) US characterization of focal hepatic lesions with intermittent high acoustic power mode and contrast material. Acad Radiol 10:739–750PubMedCrossRef
50.
Quaia E, Bartolotta TV, Midiri M et al (2006) Analysis of different contrast enhancement patterns after microbubble-based contrast agent injection in liver hemangiomas with atypical appearance at baseline scan. Abdom Imag 31(1):59–64CrossRef
51.
Rossi S, Rosa L, Ravetta V et al (2006) Contrast-enhanced versus conventional and color Doppler sonography for the detection of thrombosis of the portal and hepatic venous system. AJR 186:763–773PubMedCrossRef
52.
Wilson SR, Burns P (2006) An algorithm for the diagnosis of focal liver masses using microbubble contrast-enhanced pulse-inversion sonography. AJR 186:1401–1412PubMedCrossRef
53.
Piscaglia F, Bolondi L (2006) The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 32:1369–1375PubMedCrossRef
54.
Morel DR, Schwieger I, Hohn L et al (2000) Human pharmacokinetics and safety evaluation of SonoVue, a new contrast agent for ultrasound imaging. Invest Radiol 35:80–85PubMedCrossRef
55.
Catalano O, Sandomenico F, Matarazzo I et al (2005) Contrast-enhanced sonography of the spleen. AJR 184:1150–1156PubMed
56.
Cassano E, Rizzo S, Bozzini A et al (2006) Contrast enhanced ultrasound of breast cancer. Cancer Imaging 31:4–6CrossRef
57.
Correas JM, Claudon M, Tranquart F et al (2006) The kidney: imaging with microbubble contrast agents. Ultrasound Q 22:53–66PubMed
58.
Halpern EJ, Frausher F, Rosemberg M et al (2002) Directed biopsy during contrast-enhanced sonography of the prostate. AJR 178:915–919PubMed
59.
Holsher T, Wilkening W, Draganski B et al (2005) Transcranial ultrasound brain perfusion assessment with a contrast agent-specific imaging mode: results of a two-center trial. Stroke 36:2283–2285CrossRef
60.
Klauser A, Demharter J, De Marchi A et al (2005) Contrast enhanced grayscale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group. Eur Radiol 15:2404–2410PubMedCrossRef
61.
Krix M, Kiessling F, Farhan N (2003) A multivessel model describing replenishment kinetics of ultrasound contrast agent for quantification of tissue perfusion. US Med Biol 29:1421–1430CrossRef
62.
McCarville MB, Streck CJ, Dickson PV et al (2006) Angiogenesis inhibitors in a murine neuroblastoma model: quantitative assessment of intratumoral blood flow with contrast-enhanced gray-scale US. Radiology 240:73–81PubMedCrossRef
63.
Paltiel HJ, Kalish LA, Susaeta RA et al (2006) Pulse inversion US imaging of testicular ischemia: quantitative and qualitative analyses in a rabbit model. Radiology 239:718–729PubMedCrossRef
64.
Quaia E, Siracusano S, Bertolotto M et al (2003) Characterization of renal tumours with pulse inversion harmonic imaging by intermittent high mechanical index technique: preliminary results. Eur Radiol 13:1402–1412PubMed
65.
Rubaltelli L, Khadivi Y, Tregnaghi A et al (2004) Evaluation of lymph node perfusion using continuous mode harmonic ultrasonography with a second generation contrast agent. J Ultrasound Med 23:829–836PubMed
66.
Stieger SM, Bloch SH, Foreman O et al (2006) Ultrasound assessment of angiogenesis in a matrigel model in rats. Ultrasound Med Biol 32:673–681PubMedCrossRef
67.
Siösteen AK, Elvin A (2004) Intraoperative uses of contrast-enhanced ultrasound. Eur Radiol 14(Suppl 8):P87–P95PubMed
68.
Weber MA, Krix M, Jappe U et al (2005) Pathologic skeletal muscle perfusion in patients with myositis: detection with quantitative contrast enhanced US-initial results. Radiology 238:640–649PubMedCrossRef
69.
Wei K, Ragosta M, Thorpe J et al (2001) Non-invasive quantification of coronary blood flow reserve in humans using myocardial contrast echocardiography. Circulation 103:2560–2565PubMedCrossRef
70.
Berrocal T, Rivas S, Jaureguizar E et al (2004) Contrast-enhanced sonourethrography in the assessment of the urethra. Cir Pediatr 17:58–60PubMed
71.
Berrocal T, Gaya F, Arjonilla A (2005) Vesicoureteral reflux: can the urethra be adequately assessed by using contrast-enhanced voiding US of the bladder? Radiology 234:235–241PubMedCrossRef
72.
Bosio M, Manzoni GA (2002) Detection of posterior urethral valves with voiding cysto-urethrosonography with echo contrast. J Urol 168:1711–1715PubMedCrossRef
73.
Duran C, Valera A, Alguersuari A et al (2009) Voiding urosonography: the study of the urethra is no longer a limitation of the technique. Pediatr Radiol 39:124–131PubMedCrossRef
74.
Maté A, Bargiela A, Mosteiro S et al (2003) Contrast ultrasound of the urethra in children. Eur Radiol 13:1534–1537PubMedCrossRef
75.
Kopac M, Riccabona M, Haim M (2009) Contrast-enhanced voiding urosonography and genitography in a baby with ambiguous genitalia and urogenital sinus. Ultraschall Med 30:299–300PubMedCrossRef
76.
Papadopoulou F, Evangelou E, Darge K (2011) Contrast-enhanced voiding urosonography for diagnosis of vesicoureteric reflux in comparison to conventional methods: a meta-analysis. Oral presentation at the ESPR Pediatric Uroradiology Task Force session during the IPR in London, 28 May 2011
77.
Darge K, Zieger B, Rohrschneider W et al (2001) Reduction in voiding cystourethrographies after the introduction of contrast enhanced sonographic reflux diagnosis. Pediatr Radiol 31:790–795PubMedCrossRef
78.
Catalano O, Cusati B, Nunziata A et al (2006) Active abdominal bleeding: contrast-enhanced sonography. Abdom Imaging 31:9–16PubMedCrossRef
79.
Oldenburg A, Hohmann J, Skrok J et al (2004) Imaging of paediatric splenic injury with contrast-enhanced ultrasonography. Pediatr Radiol 34:351–354PubMedCrossRef
80.
Sparano A, Acampora C, di Nuzzo L et al (2006) Color power Doppler US and contrast-enhanced US features of abdominal solid organ injuries. Emerg Radiol 12:216–222PubMedCrossRef
81.
Thorelius L (2004) Contrast-enhanced ultrasound in trauma. Eur Radiol 14(Suppl 8):P43–P52PubMed
82.
Valentino M, Serra C, Pavlica P et al (2008) Blunt abdominal trauma: diagnostic performance of contrast-enhanced US in children—initial experience. Radiology 246:903–909PubMedCrossRef
83.
Nolsoe C, Piscaglia F, Dietrich CF et al (2011) Primum non nocere? Why can’t we use second generation Ultrasound Contrast Agents for the examination of children? Ultraschall Med 32:83–86
84.
85.
ter Haar G (2009) Safety and bio-effects of ultrasound contrast agents. Med Biol Eng Comput 47:893–900PubMedCrossRef
86.
87.
Riccabona M, Claudon M, Derchi L et al (2011) Statement of the ESPR Uroradiology Task Force and the ESUR Paediatric Work Group concerning the use and availability of ultrasound contrast agents in children. Open letter to the European Medicines Agency from November 2011. Pediatr Radiol
88.
89.
Metadata
Title
Application of a second-generation US contrast agent in infants and children—a European questionnaire-based survey
Author
Michael Riccabona
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Pediatric Radiology / Issue 12/2012
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-012-2472-5

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