Ultrasound elastography and contrast-enhanced ultrasound in infants, children and adolescents

•Elastography gives information on tissue stiffness.•Elastography is used in focal and diffuse organ disease.•Elastography is a promising new technique in children.•Contrast enhanced ultrasound gives information on tissue perfusion and reflux disease.•Contrast enhanced ultrasound use is very limited since it is not officially approved in children.

ObjectiveTo describe prerequisites, use, and safety of ultrasound elastography and contrast-enhanced ultrasound in infants, children, and adolescents.MethodThis review deals with two latest developments in ultrasonography in children. The principle of strain elastography, transient elastography, and acoustic radiation force imaging is discussed, including limitations, and advantages of the different techniques in diagnosing focal and diffuse organ disease. The intravesical (contrast-enhanced voiding ultrasonography) and intravascular use of contrast-media to outline blood, and urinary flow is described, with special emphasis on indications, off-label use, and diagnostic gain. Examples of indications for performing the advanced ultrasound techniques are presented.Summary and conclusionLatest developments in ultrasound machine engineering, and the availability of contrast-media that interact with ultrasound waves allow for assessment of tissue stiffness/elasticity properties, blood, and urinary flow. Thereby ultrasound is capable not only to depict morphology, but gives the additional information on organ, and focal lesion perfusion, and urinary flow dynamics. The information gap to other cross-sectional techniques such as magnetic resonance imaging, that make potential harmful sedation, and anaesthesia in the youngest children necessary, thereby gets closer.