Do We Really Need Intravenous Ultrasound Contrast Agents for Pediatric Patients - From Fascination To Reality - A Single Center Experience

The use of ultrasound contrast agents (UCA) in pediatric imagining still has off-label status. Although, the role of UCA in the vesico-ureteral reflux is increasing, their intravenous use is at the level of a medical experiment. In our center examinations with intravenous use of UCA are made from November 2010. Up to today about 195 studies in children from oncology department aged from 30 days to 17 years were performed. We obtained an approval of the Independent Ethical Review Board to use intravenously UCA containing sulphur hexafluoride in children with oncological diseases. In accordance to the recommendations of the Ethical Committee we had taken into consideration one fundamental principle during qualifying children to UCA examination. It was the lack of the clear diagnosis in other imagining modalities (CT, MRI, b-mode US, PET). The number of examinations performed in our center each year was as follows: 2011 - 128 , 2012 - 34, 2013 - 33. These data can be summarized briefly - from fascination in the first year to the reality in the next years. However, smaller number of examinations performed in the second and third years was the consequence of severe adverse reaction after intravenous administration of sulphur hexafluoride. This adverse event entailed from one side more rigorous qualification to the examination, on the other hand, significantly reduced interest the collaborating oncologists. At the moment, despite more than three years of experience with the intravenous use of UCA in children we cannot find the answers to many important questions : 1 What are the indications and contraindications to the study with intravenous UCA? 2 How to provide the maximum safety of the examination with UCA in children? 3 Is it possible to reduce the numerous CT studies in the pediatric population in the event of the widespread use of UCA ? 4 How to encourage and convince the surgeons and oncologists to the examinations with UCA ? We believe that these questions had everyone who performed the examinations with UCA in children.