Contrast-enhanced ultrasound of benign and malignant liver lesions in children

Cheng Fang,Sudha A Anupindi,Zoltan Harkanyi,Judy H Squires,Jeannie K Kwon,Thomas G Green,Susan J Back,Vassil N Zefov,Doris Franke,Harriet J Paltiel,Jörg Jüngert,M Beth Mccarville

doi:10.1007/s00247-021-04976-2

Abstract

Contrast-enhanced ultrasound (CEUS) is increasingly being used in children. One of the most common referrals for CEUS performance is characterization of indeterminate focal liver lesions and follow-up of known liver lesions. In this setting, CEUS is performed with intravenous administration of ultrasound contrast agents (UCAs). When injected into a vein, UCA microbubbles remain confined within the vascular network until they dissipate. Therefore, visualization of UCA within the tissues and lesions corresponds to true blood flow. CEUS enables continuous, real-time observation of the enhancement pattern of a focal liver lesion, allowing in most cases for a definite diagnosis and obviating the need for further cross-sectional imaging or other interventional procedures. The recent approval of Lumason (Bracco Diagnostics, Monroe Township, NJ) for pediatric liver CEUS applications has spurred the widespread use of CEUS. In this review article we describe the role of CEUS in pediatric liver applications, focusing on the examination technique and interpretation of main imaging findings of the most commonly encountered benign and malignant focal liver lesions. We also compare the diagnostic performance of CEUS with other imaging modalities for accurate characterization of focal liver lesions.

Highlights

Liver applications of contrast-enhanced ultrasound (CEUS) are increasingly reported in children
We review the CEUS examination technique and the typical imaging features of the most common benign and malignant pediatric liver lesions
A recent meta-analysis of 57 studies showed that CEUS has excellent diagnostic accuracy in differentiating malignant from benign focal liver lesions, with a pooled sensitivity and specificity of 0.92 (95% confidence interval [CI]: 0.91–0.93) and 0.87, respectively [83]

Summary

Introduction

Liver applications of contrast-enhanced ultrasound (CEUS) are increasingly reported in children. FLL focal liver lesion, FNH focal nodular hyperplasia, HCC hepatocellular carcinoma, NPV negative predictive value, OR odds ratio, PPV positive predictive value, Sn sensitivity, Sp specificity a Original research, contrast-enhanced ultrasound (CEUS) studies including a mixed population of children and adults for focal liver lesions. In all other studies the number of subjects is presented d Contrast agent not specified as on CT and MRI; histology at the time of resection indicated that it was a hepatic adenoma [9] In another pediatric CEUS study, the investigators reported that CEUS had a sensitivity of 82%, specificity of 100%, negative predictive value (NPV) of 88% and positive predictive value (PPV) of 100% for correctly differentiating between benign and malignant lesions, using CT, MRI or histology as reference standards [15]. Yusuf et al [8] conducted CEUS of the liver in 147 pediatric patients and were able to avoid any further diagnostic or interventional procedure in 73 (49.7%) of them

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Findings

Compliance with ethical standards