Pediatric CEUS use 'slowly' rising since FDA clearance

More clinics are using pediatric contrast-enhanced ultrasound (CEUS) after regulatory approval, according to findings published April 1 in the American Journal of Roentgenology. 

Since the expanded approval of the contrast agent Lumason in 2016 by the U.S. Food and Drug Administration (FDA), use of CEUS has slowly grown over the past several years for pediatric applications, wrote a team led by Taisa Guarilha, MD, from Children’s Hospital of Philadelphia. 

“We want practices to recognize that CEUS is a valuable and effective imaging option for certain pediatric indications and consider early adoption for the benefit of their patients,” Guarilha told AuntMinnie.com. 

The FDA expanded approved uses for Lumason (Bracco Diagnostics) in 2016 to include adult and pediatric noncardiac applications. Since then, research has focused on implementing CEUS into practice. Guarilha and colleagues noted that these studies do not address adoption patterns. 

The team investigated the national use of pediatric CEUS after FDA approval, using information from the MarketScan Research Databases from between 2016 and 2023. 

Final analysis included 602 unique patients with a median age of two years who underwent the same number of CEUS exams. Of the entire cohort, 447 children were commercially insured, while 155 were insured by Medicaid. 

CEUS use per million pediatric enrollment-years increased from 0.2 to 19.4 in the commercial database and from 0.0 to 7.8 in the Medicaid database. Of the total exams, 95.7% occurred during outpatient encounters that were not in the emergency department.  

The researchers identified the following most common primary diagnoses from CEUS exams: vesicoureteral reflux (VUR, 20.6%), unspecified hydronephrosis (10.9%), and urinary tract infection (10.4%). 

Among 25 CEUS exams with sufficient enrollment data, CT and MR imaging was performed within the next 90 days for 10 and 15 exams, respectively. 

“Escalation to CT or MRI after CEUS was low, potentially indicating infrequent inconclusive CEUS results,” the researchers wrote. 

Guarilha said the “strikingly low” number of CEUS exams in the study is believed to be an underestimation of actual numbers.

The study's insights into CEUS uptake could help track practice patterns, assess how guideline updates affect practices, and inform policy research, the authors wrote. They also highlighted that girls made up the majority of study participants, writing that this likely reflects greater ease of urethral imaging when performing CEUS in women. 

The authors noted several barriers to CEUS implementation, including the following: the need to educate ordering clinicians, to adjust workflows, to manage contrast media storage and administration procedures, to ensure staff availability for potential adverse events, and to track payer reimbursement. 

“Based on current trends, CEUS is only being used as a subspecialty in imaging centers, but it is likely to continue to grow, gradually rather than rapidly,” Guarilha told AuntMinnie.com. “In pediatrics, CEUS may become a more prominent first-line or alternative imaging modality for select conditions, especially where CEUS can replace or complement CT and MRI.” 

The team called for future research to better understand the primary barriers to adoption. 

Read the full study here.