Article
Contrast enhanced ultrasound perfusion imaging for recanalization therapy in acute stroke patients
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Authors
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Markus Florian Oertel
- Klinik für Neurochirurgie, Universitätsspital Zürich, Universität Zürich, Zürich, Switzerland
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Raluca Reitmeir
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern, Bern, Switzerland
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Jens Eyding
- Neurologische Universitätsklinik, Knappschaftskrankenhaus Bochum-Langendreer, Ruhr Universität Bochum, Bochum, Deutschland
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Roland Wiest
- Universitätsinstitut für Diagnostische und Interventionelle Neuroradiologie, Inselspital Bern, Universität Bern, Bern, Switzerland
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Andreas Raabe
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern, Bern, Switzerland
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Werner Josef Z´graggen
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern, Bern, Switzerland
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Jürgen Beck
- Universitätsklinik für Neurochirurgie, Inselspital Bern, Universität Bern, Bern, Switzerland
| Published: | June 9, 2017 |
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Outline
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Objective: Transcranial contrast enhanced ultrasound perfusion imaging (tceUPI) was demonstrated to be a viable diagnostic tool for the assessment of cerebrovascular diseases, although periinterventional tceUPI data are scarce. In the present study, the authors investigated the use and ability of tceUPI to detect physiological and pathophysiological perfused brain regions before and after recanalization therapy in acute stroke patients. For the first time, its diagnostic safety and accuracy when compared to magnetic resonance and computed tomography perfusion (CTP) imaging was evaluated.
Methods: High mechanical index tceUPI, magnetic resonance perfusion (MRP) weighted, and CTP imaging data were prospectively analyzed in acute ischemic stroke patients before and after first-time intravenous or intraarterial reperfusion therapy at a single stroke center. Time-to-peak (TTP) intensities of 10 regions of interest (ROIs) in the ischemic hemisphere were compared to 4 standardized ROIs of the non-ischemic hemisphere in each patient and categorized as either normo- and hyperperfused or hypo- and non-perfused. ROIs with a TTP >3 seconds in tceUPI and >4 seconds in MRP or CTP were considered as hypoperfusion or as nonperfusion when TTP was not measurable.
Results: Twelve patients (4 men, 8 women; mean age 77 years) and a total of 120 ROIs were included for final analysis. 78/120 preinterventional and 91/120 postinterventional UPI ROIs of the ischemic hemisphere were normo- or hyperperfused, 34/120 and 16/120 hypo- or nonperfused. 8/120 and 13/120 ROIs could not be assessed because of artifacts, respectively. There was a significant correlation of UPI with MRP and CTP data. Detection of stroke demarcation or hemorrhage was feasible in all patients. tceUPI examinations did not delay therapeutic management and no tceUPI-associated complications were observed.
Conclusion: tceUPI, a flexible and mobile examination tool, enables dynamic, repeatable, fast, safe, and reliable detection and monitoring of tissue perfusion abnormalities and its changes, and of ischemic infarct demarcation or hemorrhagic transformation before and after recanalization therapy for acute stroke. The results of tceUPI compared favorably with those of the current gold standard perfusion modalities MRP and CTP. Promising further applications of tceUPI might include imaging of subarachnoid hemorrhage and vasospasm, treatment of carotid artery stenosis, and intraoperative brain perfusion.
