Purpose: Imaging modalities play a pivotal role in paediatric malignancies and ultrasonography is the first-line technique in children. Only very limited experience exists concerning possible indications, examination strategies and perfusion characteristics of different paediatric malignancies using intravenous contrast-enhanced ultrasound (CEUS). The possible value of CEUS in different typical childhood malignancies will be presented.
Patients and Methods: More than one third of 126 children investigated with CEUS in the Paediatric Ultrasonography Unit, Hannover Medical School had paediatric malignancies. CEUS was performed in 8 children with hepatoblastoma (age range 7 days to 12 years), in 10 patients with neuroblastoma (age 4 weeks to 14 years) and in 17 children with a broad variety of malignancies. Dosages of 0.5-2 ml SonoVue and low MI technique were used.
Results: Indications for CEUS in children were the initial diagnosis of focal liver and other lesions, differentiation of uni- or multilocular lesions, follow-up before liver transplantation and exclusion of recurrence of the hepatoblastoma in the liver transplant in children with hepatoblastoma. In children with neuroblastoma and other solid organ tumours, CEUS investigations were performed for the diagnosis and follow-up of liver, spleen or kidney infiltration before and after chemotherapy.
CEUS was of great benefit for the further management of two instable, ventilated newborns: one with diffuse stage 4S neuroblastoma not visible in the CT scan and another newborn with rapidly growing multifocal hepatoblastoma with initially small hyperintense lesions in the MRI, misdiagnosed in the MRI as multiple haemangiomas.
None of the infants required sedation, none of the parents refused written informed consent (off-label use).
Conclusion: CEUS was of individual benefit in children with different paediatric oncologies. Due to repeatability, low costs, possibility of mobile investigations, missing radiation burden and possible side-effects of radiological contrast agents and a high spatial resolution, CEUS has a promising potential, especially in children. Limitations: paediatric solid tumours are rare (e.g. heptatoblastoma 1% and neuroblastoma 8% of all paediatric malignancies) and the investigated children were in different stages of disease and treatment at the time point of CEUS.
Further studies should evaluate the future role of CEUS in the management of children with solid organ malignancies.
