Radiation reduction in the follow-up of abdominal trauma imaging using contrast-enhanced ultrasound

Transcription

1 Radiation reduction in the follow-up of abdominal trauma imaging using contrast-enhanced ultrasound Poster No.: B-0892 Congress: ECR 2015 Type: Authors: Keywords: DOI: Scientific Paper A. Deganello, E. Konstantatou, O. Romanos, M. Sellars, P. Sidhu; London/UK Abdomen, Pediatric, Trauma, Ultrasound, CT, Contrast agentintravenous, Radiation safety /ecr2015/B-0892 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 7

2 Purpose To determine the value of CEUS in the follow-up of trauma patients, who sustained blunt or penetrating injuries to solid abdominal viscera in comparison to CT, which remains the gold-standard, in order to reduce the radiation exposure dose. Methods and materials Single-center retrospective review of CT database of children and young adults referred for abdominal trauma over a 16-year period ( ). CT scans were performed with post- contrast split-bolus or dual-phase protocol depending on the indication. We documented the number of CT and CEUS scans performed at follow-up and, when both available, we compared their results. We also recorded the number of patients who had CEUS alone as follow-up investigation. CEUS scans were performed by experienced radiologists, following informed parental consent with no adverse events. Normal 0 false false false EN-US JA X-NONE Results A total of 766 children and young adults, (Female=161, Male=605, mean age 15yrs, range 9m-20y) were referred to CT for abdominal trauma. 112/766 (14.6%) patients had at least one follow up CT scan for solid organ abdominal injury, and of these, 37/112 (33%) patients underwent CEUS: in all cases complications were correctly diagnosed on CEUS when compared to CT, and in 3 of these cases CEUS diagnosed lesions not seen on CT. After the introduction of CEUS in 2011, 30/75 (40%) patients followed-up for solid organ injury at presentation had CEUS only with no further CT evaluation. 2 additional trauma patients aged 12 and 11yrs were initially and solely investigated with CEUS due to low grade mechanism of injury. Images for this section: Page 2 of 7

3 Fig. 1: This patient sustained blunt abdominal trauma and initial CT (b) demonstrated a splenic pseudoaneurysm. a) Follow up B-Mode demonstrated a focal hypoechoic area in the splenic parenchyma which was vascularised on colour Doppler (c). d) The subsequent CEUS cond=firmed the stability of the splenic pseudoaneurysm. The patient was offered embolisation treatment due to the lesion's size. Page 3 of 7

4 Fig. 2: This a patient with grade 3 renal injury, following blunt trauma. Initial CT (b) demonstrated the renal fracture with renal parenchyma hypo perfusion and surrounding haematoma. B-Mode (a) follow up was performed after a week which cannot reveal the remaining injury. After the administration of 1.2 ml SonoVue contrast (c,d) the left lower pole of the kidney injury is demonstrated clearly as a non perfused area. No evidence of pseudoaneyrysm or surrounding haematoma is seen. Page 4 of 7

5 Fig. 3: This is a follow up of a grade 1 liver fracture. B-Mode (a) and colour Doppler (b), cannot reveal the area of interest. CEUS (b, d) demonstrate clearly the residual injury with expected evolution and no associated complications. Page 5 of 7

6 Conclusion Our experience demonstrates the usefulness and accuracy of CEUS compared to CT in the follow up of hepatic, renal and splenic injuries. With the introduction of CEUS we were able to reduce the number of CT scans performed in the follow up of these patients, reducing substantially the high cumulative radiation burden in a particularly susceptible population. The use of CEUS in children is an off-labeled practice, as no dedicated clinical trial has been conducted; however as with the majority of medication prescribed to children, its safety has been confirmed in the everyday clinical practice in Europe and the US. Darge K. et al. have recently published a review for the safety of the contrast in children. No severe adverse incidents were reported. This is a radiation free technique, which saves the pediatric and potentially all patients from the long life risk of radiation related cancer induction with results similar to those of CT. We were able to demonstrate all trauma related complications and follow up the patient up to complete resolution of the lesions with no adverse incidents. The potential use of CEUS in tauma patient management is thought to be crucial and is introduced in our Institution. Personal information References ADDIN EN.REFLIST 1. Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsoe CP, et al. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound in medicine & biology. 2013;39(2): Valentino M, Serra C, Pavlica P, Labate AM, Lima M, Baroncini S, et al. Blunt abdominal trauma: diagnostic performance of contrast-enhanced US in children--initial experience. Radiology. 2008;246(3): Piscaglia F, Bolondi L, Italian Society for Ultrasound in M, Biology Study Group on Ultrasound Contrast A. The safety of Sonovue in abdominal applications: retrospective analysis of investigations. Ultrasound in medicine & biology. 2006;32(9): Page 6 of 7

7 4. Darge K, Papadopoulou F, Ntoulia A, Bulas DI, Coley BD, Fordham LA, et al. Safety of contrast-enhanced ultrasound in children for non-cardiac applications: a review by the Society for Pediatric Radiology (SPR) and the International Contrast Ultrasound Society (ICUS). Pediatric radiology. 2013;43(9): McCarville MB, Kaste SC, Hoffer FA, Khan RB, Walton RC, Alpert BS, et al. Contrast-enhanced sonography of malignant pediatric abdominal and pelvic solid tumors: preliminary safety and feasibility data. Pediatric radiology. 2012;42(7): Doria AS, Guarniero R, Cunha FG, Modena M, De Godoy RM, Jr., Luzo C, et al. Contrast-enhanced power Doppler sonography: assessment of revascularization flow in Legg-Calve-Perthes' disease. Ultrasound in medicine & biology. 2002;28(2): Doria AS, Kiss MH, Lotito AP, Molnar LJ, de Castro CC, Medeiros CC, et al. Juvenile rheumatoid arthritis of the knee: evaluation with contrast-enhanced color Doppler ultrasound. Pediatric radiology. 2001;31(7): Bonini G, Pezzotta G, Morzenti C, Agazzi R, Nani R. Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients. Journal of ultrasound. 2007;10(2): Piskunowicz M, Kosiak W, Batko T. Intravenous application of second-generation ultrasound contrast agents in children: a review of the literature. Ultraschall in der Medizin. 2012;33(2): Riccabona M. Application of a second-generation US contrast agent in infants and children--a European questionnaire-based survey. Pediatric radiology. 2012;42(12): Normal 0 false false false EN-US JA X-NONE Page 7 of 7