Contrast-enhanced ultrasound, microvascular imaging, elastography, and fat quantification have varying degrees of utility, with some applications in the pediatric setting mirroring that in adults and having unique uses when applied to children in others. This review will present novel ultrasound technologies and the clinical context in which they are applied to the pediatric abdomen. New ultrasound technologies have a broad range of applications in clinical practice and represent a powerful diagnostic tool with the potential to replace other imaging modalities, such as magnetic resonance imaging and computed tomography, in specific cases.

In imaging the neonatal brain, overcoming the diffraction limit to conventional ultrasound is required to achieve images of sufficient spatial resolution. Super-resolution imaging uses ultrasound localization microscopy to image inert microbubble contrast at high frame rates, allowing exquisite detail and flow information on intracranial vessels. However, this is a mainly research-based modality. In contrast, advanced Doppler techniques, which do not require contrast, offer flow imaging far better than that of conventional Doppler, and are readily available in the clinical setting. We discuss the pros and cons of both modalities, and the promising applications of both in the clinical setting with a series of case-examples.

Hemorrhagic hydrocephalus is a common pathology in neonates with high mortality and morbidity. Current imaging approaches fail to capture the mechanisms behind its pathogenesis. Here, we discuss the processes underlying this pathology, the metabolic dysfunction that occurs as a result, and the ways in which these metabolic changes inform novel methods of clinical imaging. The imaging advances described allow earlier detection of the cellular and metabolic changes, leading to better outcomes for affected neonates.

Contrast-enhanced ultrasound and elastography are two ultrasound technologies that are becoming increasingly popular in the evaluation of different abdominal pathologies in children. The use of these technologies has expanded the diagnostic scope of ultrasound into areas that were traditionally covered by advanced imaging modalities such as computed tomography, magnetic resonance imaging, and fluoroscopy. In this review, we summarize the use of contrast-enhanced ultrasound and elastography in the evaluation of hepatic, renal, pancreatic, splenic, urinary tract, and scrotal pathologies in children. We describe the technical aspects, applications, and limitations, intending to make readers more acquainted with the technologies.

Beckwith-Wiedemann Syndrome (BWS) predisposes children to hepatoblastoma and other cancers and requires tumor screening with abdominal ultrasound and magnetic resonance imaging (MRI) when lesions are seen. Contrast-enhanced ultrasound (CEUS) may offer an alternative to MRI, which often requires sedation. Our aim was to evaluate the diagnostic performance of CEUS compared to MRI in this group when evaluating liver lesions, to compare sedation requirements, and to assess imaging features correlated with malignancy. This was a retrospective review of patients with molecular BWS and liver lesions who underwent MRI and CEUS within 6 months. Demographics, sedation requirement, and final diagnosis (pathology or follow-up imaging) were recorded. Two blinded radiologists per category classified lesions (benign/malignant/indeterminate) and detailed imaging features. Test performance and inter-rater reliability (Cohen’s κ) were calculated. 12 patients (7 females, mean age 3 months) were included. A final diagnosis of 3 hepatoblastomas and 9 benign lesions was derived from pathology in 4 cases and from imaging follow-up in 8. Ten MRI examinations (83%) and no CEUS examinations required sedation. On consensus read, CEUS had a sensitivity of 67% and a specificity of 89%; κ = 0.70. MRI had a sensitivity of 75% and a specificity of 100%; κ = 0.25. Iso-enhancement and washout on CEUS and cystic change, necrosis, and diffusion restriction on MRI correlated with malignancy. Our findings suggest that CEUS has good diagnostic accuracy and high inter-rater reliability and allows sedation avoidance, suggesting that its use could allow MRI to be reserved for indeterminate or malignant lesions.