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Meta-Analysis
. 2025 Feb;55(2):226-241.
doi: 10.1007/s00247-024-06127-9. Epub 2024 Dec 13.

Diagnostic performance of contrast-enhanced ultrasound in traumatic solid organ injuries in children: a systematic review and meta-analysis

Payam Jannatdoust  1 , Parya Valizadeh  1 , Amir Hassankhani  2   3 , Melika Amoukhteh  2   3 , Delaram J Ghadimi  4 , Mahsa Heidari-Foroozan  5   6 , Paniz Sabeghi  2 , Paniz Adli  7 , Jennifer H Johnston  8 , Pauravi S Vasavada  9 , Ali Gholamrezanezhad  10
Affiliations
Meta-Analysis

Diagnostic performance of contrast-enhanced ultrasound in traumatic solid organ injuries in children: a systematic review and meta-analysis

Payam Jannatdoust et al. Pediatr Radiol. 2025 Feb.

Abstract

Background: Blunt abdominal trauma (BAT) is a significant contributor to pediatric mortality, often causing liver and spleen injuries. Contrast-enhanced computed tomography (CT), the gold standard for diagnosing solid organ injury, poses radiation risks to children. Contrast-enhanced ultrasound (CEUS) may be a promising alternative imaging modality.

Objectives: To evaluate the diagnostic utility of CEUS for detecting solid organ injuries following BAT in the pediatric population.

Methods: A systematic review and meta-analysis were conducted through a thorough literature search in PubMed, Scopus, Web of Science, and Embase databases up to October 1, 2023. Diagnostic accuracy metrics were aggregated using a bivariate model, and subgroup meta-analysis compared CEUS accuracy across various organs.

Results: Meta-analysis from four studies, including 364 pediatric patients, revealed a pooled sensitivity of 88.5% (95%CI 82.5-92.6%) and specificity of 98.5% (95%CI 94.9-99.6%), with an area under the curve of 96% (95%CI 88 - 99%). Splenic injuries showed higher sensitivity than liver injuries (P-value < 0.01), while kidney assessments demonstrated higher specificity (P-value < 0.05).

Conclusion: This study highlights the diagnostic potential of CEUS for pediatric solid organ injuries caused by BAT. Further large-scale studies are needed due to the limited number and sample size of the included studies.

Keywords: Abdominal injuries; Blunt abdominal trauma; Contrast-enhanced ultrasound; Diagnostic imaging; Pediatric trauma; Solid organ injuries.

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Conflict of interest statement

Declarations. Ethical approval: This study, being a review and not involving patient data, did not require institutional ethical approval. Informed consent: As this study was a review and did not involve patient data, obtaining informed consent was not applicable. Generative AI and AI-assisted technologies in the writing process: We acknowledge ChatGPT, an OpenAI language model based on the GPT-4 architecture, for assisting with language corrections during the article’s editing. The model enhanced the readability and language quality of the publication. However, the authors retain full responsibility for the content, having reviewed and edited it as needed after using the tool. Conflicts of interest: None

Figures

Fig. 1
Fig. 1
PRISMA flow diagram showing the review process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Fig. 2
Fig. 2
Funnel plots for the assessment of the effect of potential publication bias/small study effect in the reported diagnostic performance indices in overall meta-analysis. FPR, false positive rate; Sen, sensitivity
Fig. 3
Fig. 3
Paired forest plots of the bivariate model random effect meta-analysis of diagnostic performance of contrast-enhanced sonography (CEUS) in diagnosing various solid organ injuries in pediatric patients (overall analysis). CI, confidence interval
Fig. 4
Fig. 4
Summary receiver operating curve (SROC) of the bivariate model random effect meta-analysis of diagnostic performance of contrast-enhanced sonography (CEUS) in diagnosing various solid organ injuries in pediatric patients (overall analysis). AUC, area under the curve; SROC, summary receiver operating curve
Fig. 5
Fig. 5
Likelihood scattergram of the bivariate model random effect meta-analysis of diagnostic performance of contrast-enhanced sonography (CEUS) in diagnosing various solid organ injuries in pediatric patients (overall analysis). The scattergram is divided into four quadrants based on likelihood ratios, with data points having a positive likelihood ratio (LRP) greater than 10 classified as optimal for confirmation, and those with a negative likelihood ratio (LRN) less than 0.1 classified as optimal for exclusion. LLQ, left lower quadrant; LRN, negative likelihood ratio; LRP, positive likelihood ratio; LUQ, left upper quadrant; RLQ, right lower quadrant; RUQ, right upper quadrant
Fig. 6
Fig. 6
Fagan’s nomogram plots with three different pre-test probability assumptions and pooled diagnostic performance indices based on the bivariate model random effect meta-analysis of diagnostic performance of contrast-enhanced sonography (CEUS) in diagnosing various solid organ injuries in pediatric patients (overall analysis). Neg, negative; NLR, negative likelihood ratio; PLR, positive likelihood ratio; Pos, positive
Fig. 7
Fig. 7
Paired forest plots of the bivariate model random effect meta-analysis of diagnostic performance of contrast-enhanced sonography (CEUS) in diagnosing solid organ injuries of the kidney, liver, and spleen in pediatric patients (subgroup analysis). CI, confidence interval
Fig. 8
Fig. 8
Summary receiver operating curves (SROCs) of the bivariate model random effect meta-analysis of diagnostic performance of contrast-enhanced sonography (CEUS) in diagnosing solid organ injuries of the kidney, liver, and spleen in pediatric patients (subgroup analysis). AUC, area under the curve; SROC, summary receiver operating curve
Fig. 9
Fig. 9
Likelihood scattergram of the bivariate model random effect meta-analysis of diagnostic performance of contrast-enhanced sonography (CEUS) in diagnosing solid organ injuries of the kidney, liver, and spleen in pediatric patients (subgroup analysis). The scattergram is divided into four quadrants based on likelihood ratios, with data points having a positive likelihood ratio (LRP) greater than 10 classified as optimal for confirmation, and those with a negative likelihood ratio (LRN) less than 0.1 classified as optimal for exclusion. CI, confidence interval; LLQ, left lower quadrant; LRN, negative likelihood ratio; LRP, positive likelihood ratio; LUQ, left upper quadrant; RLQ, right lower quadrant; RUQ, right upper quadrant
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