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Reviews and CommentaryFree Access

How I Do It: Contrast-enhanced US Applications in Children

  • Deputy Editor: Kathryn Fowler
  • Scientific Editor: Sarah Atzen
Published Online:Apr 15 2025https://doi.org/10.1148/radiol.241544
Figure 1:

Figure 1: US images depict rapidly involuting congenital hemangioma in a newborn male patient with a prenatally detected hepatic mass. (A) Transverse grayscale US image reveals a well-circumscribed, mildly echogenic mass (arrow) in the right hepatic lobe. (B–E) Transverse contrast-enhanced US images obtained in the arterial phase at (B) 8 seconds, (C) 10 seconds, and (D) 14 seconds and in the (E) portal venous phase demonstrate progressive centripetal enhancement of the mass. (F) Transverse grayscale US image obtained in follow-up at 7 months of age shows complete resolution of the right hepatic lobe mass.

Figure 2:

Figure 2: Contrast-enhanced voiding urosonography images in a 2-month-old female patient with bilateral vesicoureteral reflux and intrarenal reflux. (A) Coronal image shows reflux of contrast material into both ureters (u) and the collecting system of the right kidney (R). Intrarenal reflux from multiple calyces is identified (arrowheads). (B) Coronal image reveals pronounced intrarenal reflux into the left kidney (L) with associated parenchymal opacification. (C) Longitudinal transperineal image obtained during voiding depicts a normal urethra (arrowhead). Bl = bladder.

Figure 3:

Figure 3: Images in a 1-day-old female patient with bilateral temporal lobe ischemic stroke. (A) Dual-screen display image of the brain in the coronal plane. Reference grayscale US image (left) shows subtle hyperechogenicity of both temporal lobes (arrows) with a loss of normal gray-white matter differentiation. Contrast-enhanced US image (right) shows nonenhancement of both temporal lobes (arrows), confirming infarction. (B) Coronal T2-weighted MRI scan demonstrates corresponding high signal intensity in both temporal lobes (arrows).

Figure 4:

Figure 4: Images in a 3-year-old male patient with necrotizing pneumonia. (A) Transverse grayscale US image of the left chest shows lung (L) consolidation with scattered hypoechoic zones (arrowheads) concerning for necrosis. Pleural fluid (asterisks) surrounds the lung. (B) Transverse contrast-enhanced US image of the left chest reveals foci of absent perfusion (arrowheads) in keeping with necrosis. Asterisks indicate pleural fluid. H = heart. (C) Transverse contrast-enhanced CT image of the left lung corroborates the presence of multifocal necrosis (arrowheads). Asterisk indicates pleural fluid.

Figure 5:

Figure 5: US images in an 11-year-old male patient with splenic devascularization after blunt abdominal trauma. (A) Longitudinal grayscale US image of the spleen (between cursors) reveals marked parenchymal heterogeneity. There is a small anechoic fluid collection (asterisk) along its superomedial aspect. (B) Longitudinal portal venous phase contrast-enhanced US image of the spleen depicts complete devascularization.

Figure 6:

Figure 6: Images in a female neonate with hypoxic-ischemic brain injury. Dual-screen coronal images of the brain (A) during the early arterial phase of enhancement and (B) the corresponding perfusion map, each with reference grayscale images on the left side of each panel. Regions of interest (ROIs) have been placed over both hemispheres (red), right (yellow) and left (green) thalami, and right (white) and left (purple) subcortical gray matter. The blue line indicates the zone selected for quantification analysis. The perfusion map demonstrates hyperperfusion of the central brain structures in comparison with the periphery. (C) Time-intensity curves generated from the regions of interest demonstrate a steeper curve with higher peak values in both thalami (yellow and green curves) in comparison with the subcortical gray matter (white and purple curves).