Contrast-enhanced sonography of malignant pediatric abdominal and pelvic solid tumors: preliminary safety and feasibility data

Abstract

Background: Little information exists regarding pediatric contrast-enhanced US.

Objective: To assess the safety and feasibility of contrast-enhanced US of pediatric abdominal and pelvic tumors.

Materials and methods: This prospective study included eight boys and five girls (mean age, 10.8 years) with abdominal or pelvic tumors. Cohorts of three subjects underwent US with perflutren contrast agent at escalating dose levels. Neurological and funduscopic examination, electrocardiography and continuous pulse oximetry were performed before and after contrast administration. Three radiologists independently scored six imaging parameters on pre- and postcontrast sonography. Inter-reviewer agreement was measured by the Kappa statistic.

Results: No neurological, retinal, electrocardiographical or pulse oximetry changes were attributable to the contrast agent. Two subjects reported minor, transient symptoms. Postcontrast US parameter scores improved slightly in 8 of 12 subjects. Postcontrast ultrasound inter-reviewer agreement improved slightly for detection of tumor margins (precontrast = 0.20, postcontrast = 0.26), local tumor invasion (precontrast = -0.01, postcontrast = 0.10) and adenopathy (precontrast = 0.35, postcontrast = 0.44).

Conclusions: Although our sample size is small, perflutren contrast agents appear to be safe and well tolerated in children. Contrast-enhanced sonography of pediatric abdominal and pelvic tumors is feasible, but larger studies are needed to define their safety and efficacy in children.

Figures

Fig. 1

17-year-old boy with pelvic metastasis of renal rhabdoid tumor. (a) Non–contrast-enhanced transverse ultrasound (US) image showing the pelvic tumor (arrows). (b) After administration of 0.24 mL of perflutren contrast agent, the mass (arrows) is more echogenic, indicating enhancement of viable tumor. (c) Contrast-enhanced computed tomography (CT) image of the pelvic tumor (arrows) shows tumor configuration and definition of margins similar to that seen on US

Fig. 1

17-year-old boy with pelvic metastasis of renal rhabdoid tumor. (a) Non–contrast-enhanced transverse ultrasound (US) image showing the pelvic tumor (arrows). (b) After administration of 0.24 mL of perflutren contrast agent, the mass (arrows) is more echogenic, indicating enhancement of viable tumor. (c) Contrast-enhanced computed tomography (CT) image of the pelvic tumor (arrows) shows tumor configuration and definition of margins similar to that seen on US

Fig. 1

17-year-old boy with pelvic metastasis of renal rhabdoid tumor. (a) Non–contrast-enhanced transverse ultrasound (US) image showing the pelvic tumor (arrows). (b) After administration of 0.24 mL of perflutren contrast agent, the mass (arrows) is more echogenic, indicating enhancement of viable tumor. (c) Contrast-enhanced computed tomography (CT) image of the pelvic tumor (arrows) shows tumor configuration and definition of margins similar to that seen on US

Fig. 2

12-year-old boy with hepatocellular carcinoma and local nodal metastasis. (a) Non–contrast-enhanced transverse US image near the porta hepatis shows enlarged metastatic nodes (arrows) and main portal vein (curved arrow). (b) After administration of 0.56 mL of perflutren contrast agent, the main portal vein is opacified (curved arrow) and the relationship between the portal vein and adjacent node (straight arrows) is well defined. (c) Contrast-enhanced CT image at the level of the porta hepatis shows the enlarged node (arrows) adjacent to the main portal vein (curved arrow) as demonstrated by CEUS

Fig. 2

12-year-old boy with hepatocellular carcinoma and local nodal metastasis. (a) Non–contrast-enhanced transverse US image near the porta hepatis shows enlarged metastatic nodes (arrows) and main portal vein (curved arrow). (b) After administration of 0.56 mL of perflutren contrast agent, the main portal vein is opacified (curved arrow) and the relationship between the portal vein and adjacent node (straight arrows) is well defined. (c) Contrast-enhanced CT image at the level of the porta hepatis shows the enlarged node (arrows) adjacent to the main portal vein (curved arrow) as demonstrated by CEUS

Fig. 2

12-year-old boy with hepatocellular carcinoma and local nodal metastasis. (a) Non–contrast-enhanced transverse US image near the porta hepatis shows enlarged metastatic nodes (arrows) and main portal vein (curved arrow). (b) After administration of 0.56 mL of perflutren contrast agent, the main portal vein is opacified (curved arrow) and the relationship between the portal vein and adjacent node (straight arrows) is well defined. (c) Contrast-enhanced CT image at the level of the porta hepatis shows the enlarged node (arrows) adjacent to the main portal vein (curved arrow) as demonstrated by CEUS

Fig. 3

6-year-old boy with Wilms tumor. (a) Non–contrast-enhanced transverse US image of the primary right renal tumor (arrows). (b) After administration of 0.25 mL of perflutren contrast agent, there is slight enhancement in the lateral aspect of the tumor (arrows). Note that tumor margin is not well defined on pre- or post-contrast US images. (c) Contrast-enhanced CT image of the tumor better defines the interface between tumor and normal renal parenchyma (arrows)

Fig. 3

6-year-old boy with Wilms tumor. (a) Non–contrast-enhanced transverse US image of the primary right renal tumor (arrows). (b) After administration of 0.25 mL of perflutren contrast agent, there is slight enhancement in the lateral aspect of the tumor (arrows). Note that tumor margin is not well defined on pre- or post-contrast US images. (c) Contrast-enhanced CT image of the tumor better defines the interface between tumor and normal renal parenchyma (arrows)

Fig. 3

6-year-old boy with Wilms tumor. (a) Non–contrast-enhanced transverse US image of the primary right renal tumor (arrows). (b) After administration of 0.25 mL of perflutren contrast agent, there is slight enhancement in the lateral aspect of the tumor (arrows). Note that tumor margin is not well defined on pre- or post-contrast US images. (c) Contrast-enhanced CT image of the tumor better defines the interface between tumor and normal renal parenchyma (arrows)