Anupindi Sudha A, Biko David M, Ntoulia Aikaterini, Poznick Laura, Morgan Trudy A, Darge Kassa, Back Susan J
From the Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104.
Radiographics. 2017 Oct;37(6):1632-1647. doi: 10.1148/rg.2017170073.
Ultrasonography (US) is often the first line of imaging for the examination of children suspected of having liver lesions. However, gray-scale US with color Doppler imaging has limitations. The use of US contrast agents has recently been approved by the U.S. Food and Drug Administration (FDA). Compared with other imaging modalities, contrast material-enhanced US (CEUS) enables the assessment of contrast enhancement patterns with a higher temporal resolution and is therefore becoming a valuable alternative imaging technique. CEUS is advantageous owing to its high safety profile; lower cost, compared with the costs of conventional contrast-enhanced computed tomographic and magnetic resonance imaging examinations; reliability; and reproducibility. Furthermore, US examinations obviate the use of sedation, ionizing radiation, and iodinated or gadolinium-based contrast agents. All of these are desirable attributes for an imaging examination for children, the most vulnerable of patients. Focal liver lesions in children are commonly discovered incidentally, and this can pose a dilemma in terms of diagnosis and management. Owing to the FDA's recent approval of the use of a specific US contrast agent for evaluation of focal liver lesions in pediatric patients, CEUS can now be used as a problem-solving tool that complements conventional imaging examinations and aids in the follow-up of lesions. The temporal resolution with CEUS enables US images to readily depict the real-time internal vascularity of a lesion. The characterization of a lesion during different phases of enhancement improves diagnostic confidence and treatment. In this article, the authors review the composition, physiologic properties, and safety profile of CEUS; describe the technique for performing CEUS; and highlight the utility of this examination in the assessment of common focal liver lesions in children. Online supplemental material is available for this article. RSNA, 2017.
超声检查（US）通常是对疑似患有肝脏病变儿童进行检查的首选影像学方法。然而，灰阶超声联合彩色多普勒成像存在局限性。美国食品药品监督管理局（FDA）最近已批准使用超声造影剂。与其他成像方式相比，超声造影增强超声（CEUS）能够以更高的时间分辨率评估造影剂增强模式，因此正成为一种有价值的替代成像技术。CEUS具有诸多优势，包括安全性高；与传统增强计算机断层扫描和磁共振成像检查相比成本较低；可靠性高；可重复性强。此外，超声检查无需使用镇静剂、电离辐射以及碘化或钆基造影剂。所有这些都是针对儿童这一最脆弱患者群体的理想成像检查特性。儿童肝脏局灶性病变通常是偶然发现的，这在诊断和管理方面可能会造成两难局面。由于FDA最近批准使用一种特定的超声造影剂来评估儿科患者的肝脏局灶性病变，CEUS现在可作为一种解决问题的工具，补充传统成像检查并有助于病变的随访。CEUS的时间分辨率使超声图像能够轻松描绘病变的实时内部血管情况。在不同增强阶段对病变进行特征描述可提高诊断信心并指导治疗。在本文中，作者回顾了CEUS的成分、生理特性和安全性；描述了CEUS的操作技术；并强调了该项检查在评估儿童常见肝脏局灶性病变中的作用。本文提供在线补充材料。RSNA，2017年。
