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11.09.2017 | Original Article

Influence of contrast-enhanced ultrasound administration setups on microbubble enhancement: a focus on pediatric applications

verfasst von: Michael R. Kramer, Nishi Bhagat, Susan J. Back, Laura Poznick, Flemming Forsberg, Kassa Darge, John R. Eisenbrey

Erschienen in: Pediatric Radiology | Ausgabe 1/2018

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Abstract

Background

In pediatrics, contrast-enhanced ultrasound offers high-quality imaging with an excellent safety profile.

Objective

To investigate the effects of varying intravenous administration setups on in vitro enhancement and concentration of two commercially available ultrasound contrast agents, taking into consideration potential pediatric applications.

Materials and methods

We quantified in vitro enhancement using a flow phantom (ATS Laboratories, Bridgeport, CT) and Acuson S3000 ultrasound system (Siemens Healthineers, Mountain View, CA) with a 9L4 probe in Cadence pulse sequencing mode. We determined microbubble concentration with an LSRII flow cytometer (BD Biosciences, San Jose, CA). We investigated Optison (GE Healthcare, Princeton, NJ) and Lumason (Bracco, Geneva, Switzerland) ultrasound contrast agents. The ultrasound (US) contrast agent was injected via a 1 mL syringe and flushed with 5 mL of saline through a 22-gauge diffusion catheter (BD Medical, Franklin Lakes, NJ) with the following variations: in-line injection through a 3-way stopcock with and without a neutral displacement connector (ICU Medical, San Clemente, CA), perpendicular through a 3-way stopcock with and without a connector, and without a 3-way stopcock. We also conducted injections through a 22-gauge standard angiocatheter.

Results

Injection through the connector and perpendicular injection via the 3-way stopcock resulted in significant decreases in enhancement for both ultrasound contrast agents (P<0.0001). Injection through the connector resulted in significant decrease in concentration for Optison (P<0.05). Neither addition of the 3-way stopcock (P>0.24) nor use of a pediatric diffusion catheter (P>0.28) affected the enhancement.

Conclusion

Ultrasound contrast agent enhancement depends on the administration route, although some effects appear to be specific to the ultrasound contrast agent used. To avoid loss of enhancement, neutral displacement connectors and perpendicular injection should be avoided.

Goldberg BB, Raichlen JS, Forsberg F (2001) Ultrasound contrast agents: basic principles and clinical applications, 2nd edn. Martin Dunitz, London

Eisenbrey J, Daecher A, Kramer M, Forsberg F (2015) Effects of needle and catheter size on commercially available ultrasound contrast agents. J Ultrasound Med 34:1961–1968CrossRefPubMed

Talu E, Powell RL, Longo ML, Dayton PA (2008) Needle size and injection rate impact microbubble contrast agent population. Ultrasound Med Biol 34:1182–1185CrossRefPubMedPubMedCentral

Barrack T, Stride E (2009) Microbubble destruction during intravenous administration: a preliminary study. Ultrasound Med Biol 35:512–522CrossRef

Schreiber-Dietrich D, Dietrich CF (2012) Contrast enhanced ultrasound (CEUS) and off-label use (in children). Ultraschall Med 33:295–296CrossRefPubMed

Esposito F, Di Serafino M, Sgambati P et al (2012) Ultrasound contrast media in paediatric patients: is it an off-label use? Regulatory requirements and radiologist’s liability. Radiol Med 117:148–159CrossRefPubMed

Bracco Diagnostics (2016) First approval by U.S. Food and Drug Administration for contrast enhanced ultrasonography of the liver received by Bracco Diagnostics Inc. for LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use. http://www.prnewswire.com/news-releases/first-approval-by-us-food-and-drug-administration-for-contrast-enhanced-ultrasonography-of-the-liver-received-by-bracco-diagnostics-inc-for-lumason-sulfur-hexafluoride-lipid-type-a-microspheres-for-injectable-suspension-for-300245196.html. Accessed 16 July 2017

Bracco Diagnostics (2016) LUMASON (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use: full prescribing information. Bracco Diagnostics, Monroe Township

Valentino M, Serra C, Pavlica P et al (2008) Blunt abdominal trauma: diagnostic performance of contrast-enhanced US in children — initial experience. Radiology 246:903–909CrossRefPubMed

10.

Duran C, del Riego J, Riera L et al (2012) Voiding urosonography including urethrosonography: high-quality examinations with an optimised procedure using a second-generation US contrast agent. Pediatr Radiol 42:660–667CrossRefPubMed

11.

Ascenti G, Zimbaro G, Mazziotti S et al (2004) Harmonic US imaging of vesicoureteric reflux in children: usefulness of a second generation US contrast agent. Pediatr Radiol 34:481–487CrossRefPubMed

12.

Kis E, Nyitrai A, Varkonyi I et al (2010) Voiding urosonography with second-generation contrast agent versus voiding cystourethrography. Pediatr Nephrol 25:2289–2293CrossRefPubMed

13.

Papadopoulou F, Anthopoulou A, Siomou E et al (2009) Harmonic voiding urosonography with a second-generation contrast agent for the diagnosis of vesicoureteral reflux. Pediatr Radiol 39:239–244CrossRefPubMed

14.

Bonini G, Pezzotta G, Morzenti C et al (2007) Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients. J Ultrasound 10:99–106CrossRefPubMedPubMedCentral

15.

Papadopoulou F, Ntoulia A, Siomou E et al (2011) Safety of intravesical use of a second generation US contrast agent in children for vesicoureteric reflux detection. ECR book of abstracts, Insights Imaging 3:SS 1612, B-736

16.

McCarville MB, Kaste SC, Hoffer FA et al (2012) Contrast-enhanced sonography of malignant pediatric abdominal and pelvic solid tumors: preliminary safety and feasibility data. Pediatr Radiol 42:824–833CrossRefPubMedPubMedCentral

17.

Hadaway L, Richardson D (2010) Needleless connectors: a primer on technology. J Infus Nurs 33:22–31CrossRefPubMed

18.

Btaiche I, Kovacevich D, Khalidi N, Papke L (2011) The effects of needleless connectors on catheter-related thrombotic occlusions. J Infus Nurs 34:89–95CrossRefPubMed

19.

Johnson PT, Christensen GM, Fishman EK (2014) I.V. contrast administration with dual source 128-MDCT: a randomized controlled study comparing 18-gauge nonfenestrated and 20-gauge fenestrated catheters for catheter placement success, infusion rate, image quality, and complications. AJR Am J Roentgenol 202:1166–1170CrossRefPubMed

20.

Grigioni M, Daniele C, Morbiducci U et al (2002) Computational model of the fluid dynamics of a cannula inserted in a vessel: incidence of the presence of side holes in blood flow. J Biomech 35:1599–1612CrossRefPubMed

21.

Park JY, Park CY, Min BG (2007) A numerical study on the effect of side hole number and arrangement in venous cannulae. J Biomech 40:1153–1157CrossRefPubMed

22.

Daniel TB, Akins EW, Hawkins IF Jr (1990) A solution to the problem of high-flow jets from miniature angiographic catheters. AJR Am J Roentgenol 154:1091–1005CrossRefPubMed

23.

Wienbeck S, Fischbach R, Kloska SP et al (2010) Prospective study of access site complications of automated contrast injection with peripheral venous access in MDCT. AJR Am J Roentgenol 195:825–829CrossRefPubMed

24.

Claudon M, Dietrich CF, Choi BI et al (2013) 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 Med Biol 39:187–210CrossRefPubMed

25.

Back SJ, Edgar JC, Canning DA, Darge K (2015) Contrast-enhanced voiding urosonography: in vitro evaluation of a second-generation ultrasound contrast agent for in vivo optimization. Pediatr Radiol 45:1496–1505CrossRefPubMed

26.

Shaw CM, Eisenbrey JR, Lyshchik A et al (2015) Contrast-enhanced ultrasound evaluation of residual blood flow to hepatocellular carcinoma after treatment with transarterial chemoembolization using drug-eluting beads: a prospective study. J Ultrasound Med 34:859–867CrossRefPubMed

27.

Eisenbrey JR, Machado P, Shaw CM et al (2014) Evaluation of renal mass cryoablation with contrast-enhanced harmonic and subharmonic ultrasound: preliminary results and dosage optimization [abstract]. J Ultrasound Med 33:S11

28.

Wilson S, Kim TK, Jang HJ, Burns P (2007) Enhancement patterns of focal liver masses: discordance between contrast-enhanced sonography and contrast-enhanced CT and MRI. AJR Am J Roentgenol 189:W7–W12CrossRefPubMed

29.

Jung EM, Clevert DA, Rupp N (2003) Contrast-enhanced ultrasound with Optison in percutaneous thermoablation of liver tumors [in German]. Rofo 175:1403–1412CrossRefPubMed

30.

Luo W, Numata K, Kondo M et al (2009) Sonazoid-enhanced ultrasonography for evaluation of the enhancement patterns of focal liver tumors in the late phase by intermittent imaging with a high mechanical index. J Ultrasound Med 28:439–448CrossRefPubMed

31.

Trillaud H, Bruel JM, Valette PJ et al (2009) Characterization of focal liver lesions with SonoVue-enhanced sonography: international multicenter-study in comparison to CT and MRI. World J Gastroenterol 15:3748–3756CrossRefPubMedPubMedCentral

32.

Papadopoulou F, Ntoulia A, Siomou E, Darge K (2014) Contrast-enhanced voiding urosonography with intravesical administration of a second-generation ultrasound contrast agent for diagnosis of vesicoureteral reflux: prospective evaluation of contrast safety in 1,010 children. Pediatr Radiol 44:719–728CrossRefPubMed

33.

Paefgen V, Doleschel D, Kiessling F (2015) Evolution of contrast agents for ultrasound imaging and ultrasound-mediated drug delivery. Front Pharmacol 6:197CrossRefPubMedPubMedCentral

34.

Bracco Diagnostics (2016) Bracco Diagnostics Inc.’s LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension, for intravenous use or intravesical use, receives U.S. Food and Drug Administration approval for use in ultrasonography of the urinary tract in pediatric patients for the evaluation of suspected or known vesicoureteral reflux. http://www.prnewswire.com/news-releases/bracco-diagnostics-incs-lumason-sulfur-hexafluoride-lipid-type-a-microspheres-for-injectable-suspension-for-intravenous-use-or-intravesical-use-receives-us-food-and-drug-administration-approval-for-use-in-ultrasonography--300389247.html. Accessed 16 July 2017

35.

Sun C, Panagakou I, Sboros V et al (2016) Influence of temperature, needle gauge and injection rate on the size distribution, concentration and acoustic responses of ultrasound contrast agents at high frequency. Ultrasonics 70:84–91CrossRefPubMed

36.

GE Healthcare (1997) Optison package insert https://promo.gelifesciences.com/gl/OPTISONIMAGING/misc/Updated-Optison-PI-10-21-14.pdf. Accessed 11 Feb 2017

37.

Bracco Diagnostics (2014) Lumason package insert. http://imaging.bracco.com/sites/braccoimaging.com/files/technica_sheet_pdf/us-en-2017-01-04-spc-lumason.pdf. Accessed 11 Feb 2017

Titel: Influence of contrast-enhanced ultrasound administration setups on microbubble enhancement: a focus on pediatric applications
verfasst von: Michael R. Kramer
Nishi Bhagat
Susan J. Back
Laura Poznick
Flemming Forsberg
Kassa Darge
John R. Eisenbrey
Publikationsdatum: 11.09.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Radiology / Ausgabe 1/2018
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-017-3976-9

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Influence of contrast-enhanced ultrasound administration setups on microbubble enhancement: a focus on pediatric applications