Contrast-Enhanced Ultrasound Task Force

Task Force Objectives

  • Help promote contrast ultrasound (CEUS) as a useful, low cost, radiation free imaging modality in pediatric imaging.
  • Develop relationships with manufacturers, regulators, media, other imaging organizations, and appropriate advocacy groups.
  • Explore ways of developing CEUS as a useful, practical imaging tool, including clinical trials and off label use.
  • Encourage scientific research involving CEUS
  • Help educate SPR members, pediatricans, and parents about the benefits of CEUS in pediatric imaging.
  • Help coordinate/support multicenter clinical trials involving CEUS


Task Force Members

Kassa Darge (Chair)
Dept of Radiology
Children's Hospital of Philadelphia

Harriet Paltiel
Children's Hospital Boston

Frank Volberg
Georgetown University

Beth McCarville
St Jude Children's Research Hospital

Brian Coley
Cincinnati Children's Hospital Medical Center

Dorothy Bulas
Childrens National Medical Center, Washington DC           

Lynn Fordham
UNC School of Medicine

Sara O'Hara
Cincinnati Children's Hospital Medical Center

Jonathan Dillman
University of Michigan Medical Center

International Pediatric Contrast Enhanced Ultrasound Course

International Pediatric Contrast Enhanced Ultrasound Course, London 28th February 2014

The 28th February at London’s King’s College Hospital marked the 1st International Paediatric Contrast Ultrasound Course. 

Contrast enhanced ultrasound remains infrequently used in the United States of America despite gaining popularity in Europe in the adult population, and employed in many clinical situations.  However microbubble contrast agents are yet to be licensed in the pediatric population and use in this situation is relatively uncharted territory.  Extending into the pediatric population would seem a logical extension of the use of microbubble contrast agents, with the express aim of reducing radiation in children. 

Organized by Professor Paul Sidhu, Dr Maria Sellars and Dr Annamaria Deganello, this course was conducted at in the Radiology Department, King’s College Hospital where extensive pediatric experience with the use of microbubble contrast agents has been accumulated over a number of years as an extension of a well-established and renowned adult practice.

This ground breaking course was split into a lecture session in the morning before a demonstration of live cases in the afternoon session.  Forty delegates attended from all over the United Kingdom and Europe, and a delegate from the USA was welcomed.

The morning lectures kicked off with a review of pediatric liver disease (Prof. Dino Hadzic) and included the history, safety and guidelines on the use of contrast ultrasound (Prof. David Cosgrove) as well as the issues of using licensing of drugs in the pediatric population (Prof. Paul Sidhu). In particular details regarding the use of off-license drugs was explored explaining why many commonly prescribed drugs are off license but are still used in the best interests of the child, without legal implications.

Further informative talks were given on the use of contrast enhanced ultrasound in clinical practice, in particular in trauma (Annamaria Deganello), characterisation of liver lesions (Maria Sellars) as well as an excellent description of contrast enhanced ultrasound voiding cystourography by Professor Kassa Darge.  A lively run-through of innovative use of the ubiquitous microbubble was undertaken by Drs. Sellars and Deganello.

The afternoon session was a demonstration of six live cases highlighting the techniques and practicalities of performing contrast enhanced ultrasound in pediatric patients, interspersed with interesting case presentations by the residents (biliary-porto fistula, testicular infarction, indeterminate liver lesion and phaeochromocytoma all demonstrated with contrast enhanced ultrasound in children).  A variety of both malignant and benign conditions were demonstrated including focal liver lesions as well as follow up of trauma cases.

Overall the first international pediatric contrast ultrasound day proved very successful and received positive feedback. Sponsorship was kindly provided by Philips, Hitachi and Siemens whilst a show of support was provided by EFSUMB (European Federation Society for Ultrasound in Medicine and Biology) and BMUS (British Medical Ultrasound Society) who endorsed the course.

Plans for next year are afoot!

Some faculty members (left to right)
Liam Woods, Annamaria Deganello, Kasse Darge, Maria Sellars, Paul Sidhu, David Cosgrove, Sanjay Bansal, Tim Yusuf.

Learning Materials

Recent Publications on Pediatric Contrast Ultrasound

ceVUS Articles by Dr. Kassa Darge

Articles from Pediatric Radiology

  • ESPR Uroradiology Task Force and ESUR Paediatric Working Group—Imaging recommendations in paediatric uroradiology, Part V: childhood cystic kidney disease, childhood renal transplantation and contrast-enhanced ultrasonography in children
    Authors: Michael Riccabona, Fred Efraim Avni, Maria Beatrice Damasio, Lil-Sofie Ording Müller, Johan G. Blickman, Kassa Darge, Maria Luisa Lobo, Frederica Papadopoulou, Pierre-Hugues Vivier, Ullrich Willi
  • Contrast-enhanced ultrasound in non-operative management of pancreatic injury in childhood
    Authors: Massimo Valentino, Stefania Sartoni Galloni, Maria Rita Rimondi, Andrea Gentili, Mario Lima, Libero Barozzi
  • Imaging of paediatric splenic injury with contrast-enhanced ultrasonography
    Authors: Anja Oldenburg, Joachim Hohmann, Jan Skrok, Thomas Albrecht
  • Contrast-enhanced sonography in pediatrics
    Author: M. Beth McCarville
  • Contrast-enhanced triggered harmonic sonography for assessment of periarticular hemodynamic changes in experimental arthritis 
    Authors: Andrea S. Doria, Raffi Karshafian, Rahim Moineddin, Arun Mohanta, Anguo Zhong, Maria Mendes, Kenneth Pritzker, Roland Jong, Peter Burns
  • Potential pediatric applications for US contrast agents: lessons from the laboratory
    Author: George A.Taylor
  • Molecular ultrasound imaging and its potential for paediatric radiology
    Authors: Isabel Kiessling & Jessica Bzyl & Fabian Kiessling

Contrast-Enhanced Ultrasound Bibliography

 

Bracco Statement

 

ESPR Uroradiology Task Force and ESUR Paediatric Working Group

 

Contrast-enhanced ultrasound (CEUS) in children: Ready for prime time in the United States!

 

News

October 2, 2012

Dr Kassa Darge has been invited to serve on the board of the International Contrast Ultrasound Society (ICUS) as the representative of the SPR. The two organizations are linking web pages, and there will be collaboration between ICUS and the SPR contrast ultrasound task force.
 
August 24, 2012

After a review of GE Healthcare's March 2012 Supplemental New Drug Application for proposed label changes, the U.S. Food and Drug Administration, or FDA, made revisions to the Prescribing Information for Optison, including removal of the statement, "In patients with pulmonary hypertension or unstable cardiopulmonary conditions, monitor vital sign measurements, electrocardiography and cutaneous oxygen saturation during and for at least 30 minutes after Optison administration", from within the previous BOXED WARNING. Similar language was also removed from the WARNING section of the label.
 
July 3, 2012

There will be a pediatric contrast ultrasound sunrise session at the SPR meeting in San Antonio on Friday morning, May 17, 2013. Many of our national leaders in this exciting emerging modality will be speaking.
 
March 28, 2012

New Images/Cases added above - IRR-VUR in meggaureter - Kassa Darge, MD, PhD & Liver Laceration & Kidney Perfursion defect Not Seen On Grey-Scale Ultrasound - Doris Franke, MD
 
March 23, 2012

The Contrast Ultrasound Task Force will be meeting in San Francisco at the SPR Annual Meeting. During the meteting, there will be discussions on relationships with manufacturers, off-label use, and investigator sponsored trials. The Task Force is hoping to have a session on Contrast Ultrasound at the 2013 SPR Annual Meeting in San Antonio, Texas.
 
September 22-23, 2011

International Contrast Ultrasound Society Bubble Conference Update. The ICUS meeting took place September 22-23 in Chicago. It was an interesting mix of bench scientists, cardiologists, and radiologists. The first part was a summary of current efforts to promote contrast ultrasound approval by ultrasound societies around the world.

Images/Cases

Dr Paul Sidhu, Dr Maria Sellars, and Dr Annamaria Deganello at Kings College Hospital, London

Child with Focal Nodular Hyperplasia, with early enhancement, demonstration of central scar, and prolonged enhancement, effectively excluding malignancy.

@Carmina Duran. MD. UDIAT-SDI, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain.

Urethra Normal

Posterior urethral valve

ceVUS video clip shoing vesicoureteral reflux, with a normal urethra on transperineal voiding images

  

                                                                                                 

 

 

 

@Frederica Papadopoulou, MD; Thessoloniki, Greece

@Beth McCarville, MD

Contrast Enhanced CT shows Liver Metastasis from Transitional Cell Carcinoma in a 16 year old boy.

Non-Contrast Enhanced Sagittal Ultrasound Image using Contrast Specific Software. Background tissue appears blue.

 

Early Arterial Phae after IV administration of a perflutren contrast agent. The contrast agent appears orange. The liver metastasis shows enhancement during this phase.

Portal-venous phase shows washout of contrast from the metastasis, a feature typical of malignant liver lesions.

  

 

@Kassa Darge, MD, PhD

 

           

CEUS with the bladder full of microbubbles and refluxing into the right ureter. Clear depiction of a right vesicoureteric reflux. No reflux on the left. Contrast specific technique with color overlay and subtraction makes the reflux detection much easier

 

CEUS with microbubbles in the right renal pelvis which is not markedly dilated. Contrast specific technique with color overlay and subtraction makes the reflux detection much easier

@Kassa Darge, MD, PhD

 

 

 

Contrast-enhanced image with color overlay showing reflux into the intrarenal collecting system.

 

Contrast-enhanced image with color overlay showing reflux, with grey scale subtracted.

@Kassa Darge, MD, PhD

@Doris Franke, MD - Medizinische Hochschule Hannover

 No definite abnormality seen

Small hematoma in hepato-renal space

 

 

Y-Shaped liver laceration and major perfusion defect lower pole, right kidney