Purpose or Case Report: Contrast-Enhanced ultrasound (CEUS) is being increasingly used in children as it offers the advantage over CT/MRI of real time imaging, low cost, lack of radiation, easy access, and no need for anesthesia. In our study, we evaluate CEUS for characterization of liver lesions in children and compared the enhancement patterns and diagnosis based on CEUS to MRI/CT in the pediatric population with liver lesions.
Methods & Materials: We retrospectively reviewed patients with liver lesions that had both CEUS and CT/MRI at our institution between 2017 and 2019. All patients underwent CEUS using 1-2 injections of Lumason at 0.03ml/kg. For each lesion, we reviewed the technique used, the enhancement pattern, presence of washout, and suspected diagnosis by CEUS and MR/CT at the time of the study. Clinical outcome or pathology results were noted when available.
Results: 16/20 patients (< 1 – 18 years old, 11 females and 9 males) had both CEUS and MR/CT. CEUS was performed before the MR/CT in 3 patients and after MR/CT in 13 patients. CEUS was performed using a Siemens Sequoia (8) and GE (8) ultrasound machines. 5 lesions showed no enhancement (2 fatty infiltrations, 2 scarring, 1 hemorrhage), 1 lesion showed early enhancement with rapid washout (neuroblastoma), 1 showed delayed washout (FNH) and 9 lesions showed enhancement without washout (4 FNH’s, 2 hemangiomas, 3 abscess/infection). CEUS was concordant with CT/MRI in 13 cases and discordant in 3 cases. In these 3, CEUS correctly diagnosed neuroblastoma metastasis, fatty infiltration, and an atypical hemangioma while MR or CT were inconclusive. No contrast reactions were noted.
Conclusions: CEUS is a safe, fast procedure that can be performed in children without the need of anesthesia and without exposure to ionizing radiation. Although our study is limited by a relatively small sample of patients, our data demonstrate excellent concordance with CT/MRI for the enhancement patterns and lesion characterization of liver lesions.