The crucial role of multimodality ultrasound in the postoperative evaluation of pediatric ischemic diseases.

Pediatric ischemic diseases are characterized by acute onset and rapid progression. Hence, it is essential to assess postoperative blood flow. Ultrasound, as a radiation-free imaging technique, is often employed to evaluate vascular perfusion in various organs. Nevertheless, conventional ultrasound is limited in detecting low-velocity blood flow and microvessels, and it is also markedly susceptible to motion artifacts in pediatric patients. Contrast-enhanced ultrasound (CEUS) and microvascular flow imaging (MFI) provide novel direction for these limitations. Here we reported four cases of ischemic diseases admitted to our hospital with detailed multimodality ultrasound features after surgery and follow ups, including CEUS in one case of neonatal renal vein thrombosis, CEUS in one case of splenic torsion, and CEUS combined with MFI in two cases of testicular torsion. CEUS revealed filling defect in four cases. MFI identified microvascular perfusion in the affected testis following surgical detorsion. During follow-up, atrophy was observed in the ischemic kidney and spleen. The testis without detectable blood flow by CEUS and MFI was surgically resected, while the retained ischemic testis exerted a transient detrimental effect on the contralateral testis.