{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:09:51Z","timestamp":1790154591977,"version":"4.0.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Radiol."],"abstract":"<jats:p>Contrast-enhanced ultrasound (CEUS) has become an important adjunct in pediatric imaging because it enables real-time assessment of microvascular perfusion without ionizing radiation and without nephrotoxic contrast media. This narrative review synthesizes current evidence and practical applications of pediatric CEUS, with emphasis on intravenous blood-pool CEUS, contrast-enhanced voiding urosonography (ceVUS), and selected luminal or hydrosonographic gastrointestinal applications. Literature was identified through targeted searches of PubMed\/MEDLINE and Google Scholar, with priority given to pediatric-specific reviews, systematic reviews, consensus or implementation papers, and key original studies, supplemented by recent publications through March 2026. Current evidence is strongest for ceVUS, focal liver lesion characterization, and targeted CEUS for hemodynamically stable blunt abdominal trauma; in contrast, many non-hepatic abdominal, bowel, interventional, emergency, and critical-care applications remain center-dependent or exploratory and require more standardized pediatric validation. Among pediatric applications, ceVUS remains the most mature and reproducible, offering high diagnostic performance without radiation while also allowing detection of intrarenal reflux. However, evidence maturity differs substantially across indications, and regulatory heterogeneity, operator dependence, reimbursement barriers, differences in technology availability, professional training requirements, limited cost-effectiveness data, and the need for standardized protocols remain important implementation challenges. This review proposes an indication-specific evidence-maturity framework that distinguishes mature applications suitable for broader adoption from center-dependent applications requiring local expertise and local protocolization, and from emerging applications requiring stronger prospective validation. The framework is intended as a pragmatic, non-validated clinical organizing tool rather than as a formal evidence-grading system. Overall, CEUS is well positioned to expand within child-centered imaging pathways that seek to maximize diagnostic yield while minimizing radiation exposure, sedation, and procedural burden.<\/jats:p>","DOI":"10.3389\/fradi.2026.1905765","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:50:17Z","timestamp":1790153417000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric contrast-enhanced ultrasound in clinical practice: evidence maturity and workflow integration"],"prefix":"10.3389","volume":"6","author":[{"given":"Han","family":"Yao","sequence":"first","affiliation":[{"name":"Department of Ultrasound, Kunming Children\u2019s Hospital (Children\u2019s Hospital Affiliated to Kunming Medical University)","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuejiao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Kunming Children\u2019s Hospital (Children\u2019s Hospital Affiliated to Kunming Medical University)","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Na","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Kunming Children\u2019s Hospital (Children\u2019s Hospital Affiliated to Kunming Medical University)","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Kunming Children\u2019s Hospital (Children\u2019s Hospital Affiliated to Kunming Medical University)","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenghao","family":"Zhanghuang","sequence":"additional","affiliation":[{"name":"Department of Urology, Kunming Children\u2019s Hospital (Children\u2019s Hospital Affiliated to Kunming Medical University)","place":["Kunming, China"]},{"name":"Yunnan Province Clinical Research Center for Children\u2019s Health and Disease; Yunnan Key Laboratory of Children\u2019s Major Disease Research, Kunming Children's Hospital","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2147","DOI":"10.1007\/s00247-020-04812-z","article-title":"Pediatric contrast-enhanced ultrasound: optimization of techniques and dosing","volume":"51","author":"Hwang","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.1007\/s00247-021-05223-4","article-title":"Contrast-enhanced ultrasound: a comprehensive review of safety in children","volume":"51","author":"Ntoulia","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2128","DOI":"10.1007\/s00247-021-05102-y","article-title":"Pediatric contrast-enhanced ultrasound: shedding light on the pursuit of approval in the United States","volume":"51","author":"Darge","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.2214\/AJR.21.25713","article-title":"Contrast-enhanced ultrasound in children: implementation and key diagnostic applications","volume":"217","author":"Squires","year":"2021","journal-title":"AJR Am J Roentgenol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2253","DOI":"10.1007\/s00247-020-04869-w","article-title":"Contrast-enhanced ultrasound of blunt abdominal trauma in children","volume":"51","author":"Paltiel","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s40477-021-00623-6","article-title":"Contrast-enhanced ultrasound in pediatric blunt abdominal trauma: a systematic review","volume":"25","author":"Pegoraro","year":"2022","journal-title":"J Ultrasound"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2181","DOI":"10.1007\/s00247-021-04976-2","article-title":"Contrast-enhanced ultrasound of benign and malignant liver lesions in children","volume":"51","author":"Fang","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"6747","DOI":"10.1007\/s00330-021-07784-2","article-title":"Development of a pediatric liver CEUS criterion to classify benign and malignant liver lesions in pediatric patients: a pilot study","volume":"31","author":"Wang","year":"2021","journal-title":"Eur Radiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s40644-024-00750-3","article-title":"Contrast enhanced ultrasound of liver lesions in patients treated for childhood malignancies","volume":"24","author":"Mostafa","year":"2024","journal-title":"Cancer Imaging"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2198","DOI":"10.1007\/s00247-020-04849-0","article-title":"Contrast-enhanced ultrasound of the kidneys and adrenals in children","volume":"51","author":"Back","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2229","DOI":"10.1007\/s00247-021-05131-7","article-title":"Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children","volume":"51","author":"Franke","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2214","DOI":"10.1007\/s00247-020-04868-x","article-title":"Contrast-enhanced ultrasound of the pediatric bowel","volume":"51","author":"Gokli","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2396","DOI":"10.1007\/s00247-020-04853-4","article-title":"Contrast-enhanced ultrasound in pediatric interventional radiology","volume":"51","author":"Acord","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2351","DOI":"10.1007\/s00247-020-04906-8","article-title":"Contrast-enhanced voiding urosonography, part 1: vesicoureteral reflux evaluation","volume":"51","author":"Ntoulia","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2368","DOI":"10.1007\/s00247-021-05116-6","article-title":"Contrast-enhanced voiding urosonography part 2: urethral imaging","volume":"51","author":"Barnewolt","year":"2021","journal-title":"Pediatr Radiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.jpurol.2021.10.023","article-title":"Contrast-enhanced voiding urosonography, a possible candidate for the diagnosis of vesicoureteral reflux in children and adolescents: a systematic review and meta-analysis","volume":"18","author":"Yousefifard","year":"2022","journal-title":"J Pediatr Urol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s00247-022-05548-8","article-title":"Prevalence of intrarenal reflux in pediatric patients on contrast-enhanced voiding urosonography","volume":"53","author":"Klein","year":"2023","journal-title":"Pediatr Radiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.3390\/biomedicines12051015","article-title":"The intrarenal reflux diagnosed by contrast-enhanced voiding urosonography (ceVUS): a reason for the reclassification of vesicoureteral reflux and new therapeutic approach?","volume":"12","author":"Saraga","year":"2024","journal-title":"Biomedicines"},{"key":"B19","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1007\/s40477-023-00858-5","article-title":"Ultrasound imaging of bowel obstruction in neonates","volume":"27","author":"Salman","year":"2024","journal-title":"J Ultrasound"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e241544","DOI":"10.1148\/radiol.241544","article-title":"How I do it: contrast-enhanced US applications in children","volume":"315","author":"Plut","year":"2025","journal-title":"Radiology"},{"key":"B21","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s10140-025-02432-4","article-title":"Contrast-enhanced ultrasound (CEUS) in urgent and emergent pediatric conditions: a comprehensive review","volume":"33","author":"Ahn","year":"2026","journal-title":"Emerg Radiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1007\/s00247-013-2832-9","article-title":"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","volume":"44","author":"Papadopoulou","year":"2014","journal-title":"Pediatr Radiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.1007\/s00330-021-08287-w","article-title":"Diagnosis of hirschsprung disease by hydrocolonic sonography in children","volume":"32","author":"Ma","year":"2022","journal-title":"Eur Radiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"446","DOI":"10.2214\/AJR.16.16700","article-title":"Retrospective analysis of the safety and cost implications of pediatric contrast-enhanced ultrasound at a single center","volume":"208","author":"Yusuf","year":"2017","journal-title":"AJR Am J Roentgenol"}],"container-title":["Frontiers in Radiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fradi.2026.1905765\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:50:18Z","timestamp":1790153418000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fradi.2026.1905765\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":24,"alternative-id":["10.3389\/fradi.2026.1905765"],"URL":"https:\/\/doi.org\/10.3389\/fradi.2026.1905765","relation":{},"ISSN":["2673-8740"],"issn-type":[{"value":"2673-8740","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]},"article-number":"1905765"}}