Kljucevsek Damjana, Vidmar Dubravka, Urlep Darja, Dezman Rok
Radiology Unit, Children's Hospital, University Medical Centre Ljubljana, Slovenia.
Institute of Radiology, University Medical Centre Ljubljana, Slovenia.
Radiol Oncol. 2016 Nov 9;50(4):347-354. doi: 10.1515/raon-2015-0042. eCollection 2016 Dec 1.
Contrast-enhanced ultrasound (CEUS) has become an established non-invasive, patient-friendly imaging technique which improves the characterization of lesions. In addition, dynamic contrast-enhanced ultrasound (DCE-US) provides valuable information concerning perfusion of examined organs. This review addresses current applications of CEUS in children, focused on DCE-US of the bowel wall in patients with Crohn disease, which enables realtime assessment of the bowel wall vascularity with semi-quantitative and quantitative assessment of disease activity and response to medical treatment.
Crohn's disease is a chronic inflammatory relapsing disease. Frequent imaging re-evaluation is necessary. Therefore, imaging should be as little invasive as possible, children friendly with high diagnostic accuracy. US with wide varieties of techniques, including CEUS/DCE-US, can provide an important contribution for diagnosing and monitoring a disease activity. Even if the use of US contrast agent is off-label in children, it is welcome and widely accepted for intravesical use, and a little less for intravenous use, manly in evaluation of parenchymal lesions. To our knowledge this is the first time that the use of DCE-US in the evaluation of activity of small bowel Crohn disease with quantitative assessment of kinetic parameters is being described in children. Even if the results of the value and accuracy of different quantitative kinetic parameters in published studies in adult population often contradict one another there is a great potential of DCE-US to become a part of the entire sonographic evaluation not only in adults, but also in children. Further control studies should be performed.
超声造影（CEUS）已成为一种成熟的非侵入性、患者友好型成像技术，可改善病变的特征描述。此外，动态对比增强超声（DCE-US）可提供有关被检查器官灌注的有价值信息。本综述阐述了CEUS在儿童中的当前应用，重点关注克罗恩病患者肠壁的DCE-US，它能够实时评估肠壁血管情况，并对疾病活动和药物治疗反应进行半定量和定量评估。
克罗恩病是一种慢性炎症复发性疾病。需要频繁进行影像学重新评估。因此，成像应尽可能微创，对儿童友好且诊断准确性高。包括CEUS/DCE-US在内的多种超声技术可为疾病活动的诊断和监测做出重要贡献。即使超声造影剂在儿童中的使用属于超说明书用药，但它在膀胱内使用中受到欢迎且被广泛接受，在静脉使用中接受程度稍低，主要用于实质病变的评估。据我们所知，这是首次描述在儿童中使用DCE-US并通过定量评估动力学参数来评估小肠克罗恩病的活动情况。尽管已发表的成人研究中不同定量动力学参数的价值和准确性结果常常相互矛盾，但DCE-US不仅在成人中，而且在儿童中都有很大潜力成为整个超声评估的一部分。应进行进一步的对照研究。
