Contrast-enhanced ultrasound for the diagnosis of abdominal solid organ injuries in children.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 42306848.
- Also identified by DOI 10.1097/TA.0000000000005076.
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Abstract
Identification of abdominal solid organ injuries in children relies on the use of computerized tomography (CT) scan, despite its radiation. Although ultrasound has a low diagnostic sensitivity for solid organ injuries, contrast-enhanced ultrasound (CEUS) has high sensitivity in single-center analyses. We conducted a prospective multicenter trial to identify the sensitivity of CEUS in the identification of abdominal solid organ injuries. Stable patients with an abdominal solid organ injury on CT scan underwent grayscale/Doppler and CEUS within 48 hours. US and CEUS images were interpreted locally and centrally by radiologists blinded to CT results and were compared with their respective CT's. Sixty-seven patients had 82 organ injuries identified on local CT review, 55 (67.1%) were identified on grayscale/Doppler ultrasound and 67 (81.7%) on CEUS. Nine organ injuries missed by CEUS were wrongly diagnosed in an organ adjacent to a CT-diagnosed organ injury. The remaining six missed organ injuries were grade 1 or 2, two of which were not seen on central CT. The local CEUS positive predictive value (PPV) was 93.0%, negative predictive value (NPV): 94.1%, sensitivity: 81.7%, and specificity: 98.0%. There were no adverse events. Image transmission concerns precluded central review of 10 injuries in 33 organs. Seventy-two organ injuries were identified on central CT, 33 of which were identified on grayscale/Doppler (45.8%) and 56 (77.8%) on CEUS. CEUS missed sixteen organ injuries, 10 of which were adjacent to a CT-identified organ injury. The remaining six missed organ injuries were grade 1 or 2. Central CEUS PPV was 91.8%, NPV: 93.3%, sensitivity: 77.8%, and specificity: 96.9%. CEUS identifies around 80% of CT-diagnosed abdominal solid organ injuries in this multicenter trial and may be a valuable first imaging study in certain children with potential abdominal solid organ injuries. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Level II.