Use of CEUS for Imaging Evaluation of Pediatric Peritonsillar Abscess

Abstract

Purpose Peritonsillar abscess can be diagnosed by B-mode ultrasound and cross-sectional imaging. The latter (with MRI being the modality of first choice in children) is associated with higher effort and risk for pediatric patients due to the administration of X-rays and/or the need of sedation. The purpose of this study is to evaluate whether the introduction of CEUS into the diagnostic algorithm for suspected pediatric peritonsillar abscess is suitable and advantageous.

Materials and methods Single-institution retrospective review of data of pediatric patients who were presented to the department of pediatric radiology for sonographic evaluation under the suspicion of peritonsillar abscess. Diagnostic performance of CEUS was evaluated by using surgical exploration or clinical follow-up as the reference standard.

Results 284 children included in the study underwent B-mode ultrasound. Mean age of all patients was 6,23 years. Peritonsillar abscess was the diagnosis in 42 patients. Diagnosis of peritonsillar abscess was made by B-mode ultrasound alone in 13 of 42 patients (31 %). In 17 of 42 patients (40 %), diagnosis was made by a combination of B-mode ultrasound and CEUS. Sensitivity rose from 37 % to 86 % in cases where B-mode ultrasound remained unclear and CEUS was used.

Conclusion Contrast-enhanced ultrasound (CEUS) is suitable and efficient for the diagnosis of peritonsillar abscess in pediatric patients. It increases the sensitivity for the diagnosis of peritonsillar abscess and thereby reduces the need of additional cross-sectional imaging for the pediatric patients.

Zusammenfassung

Ziel Peritonsillarabszesse können mittels B-Bild-Ultraschall und Schnittbildgebung diagnostiziert werden (mit MRT als Modalität der ersten Wahl). Schnittbildgebung ist aufwändiger und birgt mit der Anwendung von Röntgenstrahlen bzw. der Notwendigkeit einer Sedierung für pädiatrische Patienten Risiken. Mit der vorliegenden Arbeit soll evaluiert werden, ob die Einführung von CEUS in den diagnostischen Algorithmus bei Verdacht auf Peritonsillarabszess hierfür geeignet und vorteilhaft ist.

Material und Methode Monozentrische, retrospektive Auswertung von Daten von pädiatrischen Patienten, die in der Kinderradiologie zur Sonografie unter dem Verdacht auf einen Peritonsillarabszess vorgestellt wurden. Die diagnostische Wertigkeit des CEUS wurde unter Verwendung eines Referenzstandards evaluiert.

Ergebnisse In die Studie wurden 284 Kinder (mittleres Alter 6,23 Jahre) eingeschlossen, die mittels B-Bild-Ultraschall untersucht wurden. Ein Peritonsillarabszess wurde in 42 Fällen diagnostiziert. Bei 13 der 42 Patienten (31%) wurde die Diagnose allein mittels B-Bild-Ultraschall gestellt, bei 17 der 42 Patienten (40%) durch eine Kombination aus B-Bild-Ultraschall und CEUS. Die Sensitivität stieg in den Fällen, in denen der B-Bild-Ultraschall ein unklares Ergebnis zeigte und CEUS zum Einsatz kam, von 37% auf 86% an.

Schlussfolgerungen Kontrastmittel-Ultraschall (CEUS) ist für die Diagnostik des Peritonsillarabszesses bei pädiatrischen Patienten geeignet und vorteilhaft. Er erhöht die Sensitivität für die Diagnosestellung des Peritonsillarabszesses und reduziert hierdurch die Notwendigkeit einer Anwendung von Schnittbildgebung bei den pädiatrischen Patienten.

Keywords

CEUS - Pediatrics - Peritonsillar abscess - METHODS & TECHNIQUES - ultrasound

Publication History

Received: 01 October 2021

Accepted after revision: 23 January 2023

Accepted Manuscript online:
23 January 2023

Article published online:
07 March 2023

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