Experimental evaluation of photoacoustic coded excitation using unipolar golay codes.

Q-switched Nd:YAG lasers are commonly used as light sources for photoacoustic imaging. However, laser diodes are attractive as an alternative to Nd:YAG lasers because they are less expensive and more compact. Although laser diodes deliver about three orders of magnitude less light pulse energy than Nd:YAG lasers (tens of microjoules compared with tens of millijoules), their pulse repetition frequency (PRF) is four to five orders of magnitude higher (up to 1 MHz compared with tens of hertz); this enables the use of averaging to improve SNR without compromising the image acquisition rate. In photoacoustic imaging, the PRF is limited by the maximum acoustic time-of-flight. This limit can be overcome by using coded excitation schemes in which the coding eliminates ambiguities between echoes induced by subsequent pulses. To evaluate the benefits of photoacoustic coded excitation (PACE), the performance of unipolar Golay codes is investigated analytically and validated experimentally. PACE imaging of a copper slab using laser diodes at a PRF of 1 MHz and a modified clinical ultrasound scanner is successfully demonstrated. Considering laser safety regulations and taking into account a comparison between a laser diode system and Nd:YAG systems with respect to SNR, we conclude that PACE is feasible for small animal imaging.

A method to expedite data acquisition for multiple spatial-temporal analyses of tissue perfusion by contrast-enhanced ultrasound.

For semiquantitative analyses of tissue perfusion using contrast-enhanced ultrasound the acquisition and processing of time intensity curves (TIC) is required. These TICs can be computed for each pixel of an image plane, yielding parametric images of classification numbers like "blood volume" and "flow rate." The expenditure of time for data acquisition and analysis typically limits semiquantitative perfusion imaging to a single image plane in 2-D. 3-D techniques, however, provide a higher diagnostic value since more information (e.g., of an entire lesion) is obtained. Moreover, spatial compounding, being a 2-D-technique where an object is imaged from different viewing angles, is known to improve image quality by reducing artifacts and speckle noise. Both techniques, 3-D and compounding, call for optimized acquisition and processing of TICs in several image planes (3-D) or in several (overlapping) sections of the same image plane (compounding) to decrease the time needed for data acquisition. Here, an approach of interleaved imaging is presented which is applicable, among others, to contrast perfusion imaging using the replenishment method. The total acquisition time is decreased by sequentially scanning image planes twice for short time spans - first, immediately after microbubble destruction to record the initial rise of the TICs, and second, a sufficient time thereafter to assess final values of the TIC. Data from both periods are combined to fit a model function from which parameters are extracted such as perfusion rate and blood volume. This approach was evaluated by in vitro measurements on a perfusion-mimicking phantom for both, individual images such as would be used for volume reconstruction in 3-D and compound images obtained from full angle spatial compounding (FASC, 360 degrees ). An error analysis is conducted to derive the deviation of the extracted parameters of the proposed method compared with the conventional one. These deviations are entailed by a reduction in acquisition time of the proposed method, which can be adjusted by several parameters, depending on the prevailing flow. Optimization strategies are proposed to find optimal values for those settings.

Three-dimensional reconstruction of fine vascularity in ultrasound breast imaging using contrast-enhanced spatial compounding: in vitro analyses.

RATIONALE AND OBJECTIVES: Ultrasound image quality can be improved by imaging an object (here: the female breast) from different viewing angles in one image plane. With this technique, which is commonly referred to as spatial compounding, a more isotropic resolution is achieved while speckle noise and further artifacts are reduced. We present results obtained from a combination of spatial compounding with contrast-enhanced ultrasound imaging in three dimensions to reduce contrast specific artifacts (depth dependency, shadowing, speckle) and reconstruct vascular structures. MATERIALS AND METHODS: We used a conventional ultrasound scanner and a custom made mechanical system to rotate an ultrasound curved array probe around an object (360 degrees, 36 transducer positions). For 10 parallel image planes, ultrasound compound images were generated of a flow-mimicking phantom consecutively supplied with water and contrast agent. These compound images were combined to form a volume dataset and postprocessed to obtain a sonographic subtraction angiography. RESULTS: Image quality was significantly improved by spatial compounding for the native (ie, without contrast agent), and, in particular, for the contrast-enhanced case. After subtracting the native images from the contrast-enhanced ones, only structures supplied with contrast agent remain. This technique yields much better results for compound images than for conventional ultrasound images because speckle noise and an anisotropic resolution affect the latter. CONCLUSIONS: With the presented approach contrast specific artifacts can be eliminated efficiently, and a subtraction angiography can be computed. A speckle reduced three-dimensional reconstruction of submillimeter vessel structures was achieved for the first time. In the future, this technique can be applied in vivo to image the vascularity of cancer in the female breast.

Full angle spatial compounding for improved replenishment analyses in contrast perfusion imaging: in vitro studies.

For contrast enhanced perfusion imaging semi-quantitative methods (such as the bolus-, replenishment- or depletion-method) are commonly used to analyze the dynamic changes in concentration of contrast agent induced by insonification. In order to apply these methods and to decrease artifacts from tissue nonlinearity, perfusion imaging is conducted using decreased transmit power. However, echo signals from deeper structures are often too weak to be successfully analyzed. Furthermore, shadowing artifacts may occur as a result of high concentration of contrast agent in the beam path. Thus, those semi-quantitative methods often fail or yield ambiguous diagnoses. Imaging an object (e.g., the female breast) from multiple viewing angles (spatial compounding) may overcome these issues. In addition, spatial compounding achieves an isotropic resolution and reduces speckle and further common artifacts. In this paper we present results obtained from a combination of spatial compounding with contrast enhanced perfusion imaging. Applying the replenishment method, we extracted perfusion-related parameters and compared the conventional parametric images with the compound parametric images. We found that the compounded parametric images outperform the conventional images due to reduced noise and suppression of artifacts.

Transcranial sound field characterization.

In the scope of therapeutic ultrasound applications in the adult brain, such as sonothrombolysis in stroke, a better understanding of the intracranial acoustic properties during insonation through the temporal bone is warranted. Innovative ultrasound imaging techniques, like transcranial duplex sonography, may open new avenues to apply ultrasound for therapeutic purposes and to visually monitor the effect using the same device. The aim was to study the transcranial sound field aberrations and the changes of acoustic parameters, using a high-end duplex machine. Six cadaver skulls were insonated through the temporal bone window, using a diagnostic duplex ultrasound device. The measurements were done in a water tank, using a needle hydrophone to assess and compute acoustic parameters, such as peak intensity, peak-to-peak, peak-positive, peak-negative acoustic pressure, beam area etc. in a 2-D plane. It could be shown that the absorption and wavefront distortion effects of the temporal bone are variable among different skulls. Because of signal absorption of the bone, the mechanical index of the incident ultrasound wave drops by a factor > or =10 in most cases. However, the beam area might be increased by a factor of almost 4, because of phase aberration (i.e., defocusing). (

Ultrasonographic contrast-agent imaging of sub-millimeter vessel structures with spatial compounding: in vitro analyses.

In clinical diagnostics, ultrasonographic contrast-agent imaging gives access to medical parameters such as perfusion and vascularization. In addition to the artifacts that are typical for ultrasonic imaging, e.g., speckle noise and depth-dependent sensitivity and resolution, contrast-agent imaging shows more pronounced depth dependence and may suffer from shadowing artifacts that arise from high attenuation of the ultrasound waves by the contrast agent at high concentrations. By imaging an object from different viewing angles in one 2D image plane and summing the images obtained (spatial compounding), image quality can be increased and artifacts can be suppressed. In the present study, we combined both techniques to overcome the limitations of contrast-agent imaging. We used a commercially available ultrasound scanner and a custom-made high-precision mechanical system to rotate the ultrasound transducer fully around the object under investigation. Using this set-up, ultrasound data were acquired in reflection mode to generate a 360 degrees compound scan of a flow-mimicking phantom supplied with contrast agent.

Intraoperative ultrasound using phase inversion harmonic imaging: first experiences.

OBJECTIVE: To study the feasibility of intraoperative ultrasound using the phase inversion harmonic imaging (PIHI) technique. METHODS: Eight patients with intracranial middle cerebral artery aneurysms and five patients with arteriovenous malformations were studied after written informed consent. A first ultrasound study was performed through the intact dura mater after cranial trepanation to assess the pathology, its feeding artery, and downstream segments. A second ultrasound study was performed immediately after intervention to monitor the success of the procedure. All patients were studied using a Siemens Sonoline Antares ultrasound machine (Siemens Medical Solutions USA, Inc., Malvern, PA) before and after intravenous administration of an ultrasound contrast agent (Optison; GE Healthcare, Milwaukee, WI). Other than conventional brightness mode, PIHI is sensitive to the nonlinear acoustic response of tissue, and especially to ultrasound contrast agent microbubbles. The latter enables contrast-specific vascular imaging. RESULTS: PIHI provided anatomically detailed information. In combination with an ultrasound contrast agent, angiography-like views of the vascular pathologies, including their surrounding vessels, could be obtained. Flow velocities in afferent and downstream vascular segments, as well as inside the pathology, could be assessed. Flow dynamics inside the aneurysm sac or the arteriovenous malformation could be studied in real-time. Postintervention, contrast-enhanced PIHI could be used to immediately monitor the success of the surgical procedure. CONCLUSION: PIHI enables intraoperative visualization and morphological assessment of neurovascular pathologies, such as middle cerebral artery aneurysms or arteriovenous malformations. In combination with an ultrasound contrast agent, the flow dynamics of these lesions can be displayed in real-time.

Feasibility of contrast-enhanced sonography during resection of cerebral tumours: initial results of a prospective study.

The aim of this study was to adapt the ultrasonographical techniques developed for brain perfusion imaging to an intraoperative setting for topographic diagnosis of cerebral tumours. During surgery, the patients underwent contrast-enhanced ultrasonography (phase inversion harmonic imaging, bolus kinetic, fitted model function). Endocavity curved array (6.5EC10, 6.5 MHz) was used intraoperatively. The ultrasound contrast agent SonoVue (Bracco) was administered IV as a bolus injection. Off-line, time-intensity curves as well as perfusion maps were calculated and parameters such as peak intensity were locally extracted to characterise perfusion. Seven patients with brain tumours of different histologic types were subjected to contrast-enhanced ultrasonography during surgery. Tissue differentiation with contrast agent was superior to conventional B-mode ultrasound imaging. Intraoperative contrast-enhanced ultrasonography enabled visualisation of cerebral tumours in high spatial resolution.

Intraoperative brain ultrasound: a new approach to study flow dynamics in intracranial aneurysms.

The aim was to evaluate the potential of contrast-enhanced ultrasound to visualize the hemodynamics in intracranial aneurysms during neurosurgical intervention and to quantify the ultrasound data using digital particle image velocimetry (DPIV) technique. Aneurysms were scanned through the intact dura mater, preclipping and again postclipping after closure of the dura. After intravenous injection of Optison, angio-like views of the vascular tree surrounding the aneurysm, including the aneurysm sac, were obtained. Single ultrasound contrast agent microbubbles could be visualized in the aneurysm sac and the flow dynamics could be assessed in vivo. Spatial and temporal distributions of the velocity in the aneurysm and in the parent vessels were measured with DPIV using the backscattered signals from the microbubbles. Subsequently, the fluid stresses, vorticity, circulation, etc., were calculated from the velocity fields. We demonstrate in this paper that intraoperative contrast-enhanced ultrasound can be used to quantify the flow dynamics within an aneurysm.

Contrast-enhanced ultrasonic parametric perfusion imaging detects dysfunctional tissue at risk in acute MCA stroke.

Ultrasonic perfusion imaging predicts size and localization of acute stroke. It is unclear whether irreversibly damaged tissue can be differentiated from tissue at risk. Thirty-four patients (ischemic stroke <12 h) were included (Phase Inversion Harmonic Perfusion Imaging; bolus kinetic; fitted model function). Three patterns of perfusion were defined in 14 prespecified regions of interest (ROI): 'normal', 'hypoperfusion', and 'no perfusion'. Clinical status was assessed using the National Institutes of Health Stroke Scale (NIHSS) (at baseline and at days 2 to 4). Cranial Computed Tomography (CCT) (days 2 to 4) displayed final infarction. The pattern 'hypoperfusion' (ROIs presumably representing tissue at risk) was tested twofold: (i) Functional impairment by correlating their number with baseline NIHSS. (ii) Viability by correlating their recruitment rate to infarction with clinical course (DeltaNIHSS days 2 to 4). In addition, various predictive values were assessed. Twenty-seven patients were eligible for analysis. The sum of ROIs with 'no perfusion' and 'hypoperfusion' correlated highest with baseline NIHSS (rho=0.78, P<0.001). Recruitment of hypoperfused ROIs to infarction highly correlated with clinical course (rho=0.79, P<0.001). Clinical course dichotomized the patients into subgroups A ('stable', DeltaNIHSS>or=-3) and B ('improved', DeltaNIHSS

Transcranial ultrasound brain perfusion assessment with a contrast agent-specific imaging mode: results of a two-center trial.

BACKGROUND AND PURPOSE: The purpose of this study was to assess brain perfusion with an ultrasound contrast-specific imaging mode and to prove if the results are comparable between 2 centers using a standardized study protocol. METHODS: A total of 32 individuals without known cerebrovascular disease were included in the study. Perfusion studies were performed ipsilaterally in an axial diencephalic plane after intravenous administration of 0.75 mL of Optison. Offline time intensity curves (TIC) were generated in different anatomic regions. Both centers used identical study protocols, ultrasound machines, and contrast agent. RESULTS: In both centers, the comparison of the parameter time to peak intensity (TPI) revealed significantly shorter TPIs in the main vessel structures compared with any parenchymal region of interest (ROI), whereas no significant differences were seen between the parenchymal ROIs. The parameter peak intensity (PI) varied widely interindividually in both centers, whereas the inter-ROI comparison revealed statistical significance (P < 0.05) in most of the cases according to the following pattern: (1) lentiforme nucleus > thalamus and white matter region, (2) thalamus > white matter region, and (3) main vessel > any parenchymal structure. Similar results were achieved in both centers independently. CONCLUSIONS: The study demonstrates that brain perfusion assessment with an ultrasound contrast-specific imaging mode is comparable between different centers using the same study protocol.

Transcranial ultrasound angiography (T USA): a new approach for contrast specific imaging of intracranial arteries.

The goal was to develop an ultrasound contrast agent-specific imaging mode that offers an angiography-like view of the intracranial arteries and enables lower mechanical index MI settings compared to conventional transcranial duplex sonography. We studied 12 patients with transcranial ultrasound angiography (t USA) via the temporal bone window after an IV bolus injection of a perfluorocarbon-based microbubble contrast agent (Imagent). The aim was to display the intracranial vessel segments of the middle cerebral artery (M1, M2 and M3), the anterior cerebral artery (A1 and A2), the posterior cerebral artery (P1, P2 and P3) and the internal carotid artery (C1/2 and C3/4). t USA is a B-mode phase inversion imaging technique that uses wideband harmonic signals for image generation. We demonstrate, in this report, that t USA provides detailed anatomical display at native B-mode spatial resolution with fewer artifacts, yielding improved delineation of intracranial vessels that are in the 1- to 2-mm range.

Semiquantitative analysis of ultrasonic cerebral perfusion imaging.

The bolus kinetic in ultrasonic cerebral perfusion imaging is the most favored data acquisition and processing technique. However, there has not yet been convincing evidence for the potential to (semi-) quantitatively describe perfusion. Aim of this study was to determine the intraindividual range of relevant perfusion parameters to describe individual physiological cutoff scores. In 20 healthy volunteers, cerebral perfusion was evaluated using the bilateral approach with phase inversion harmonic imaging and the bolus kinetic. Relevant parameters (time-to-peak intensity, TPI; peak width, PW) were derived in 14 regions-of-interest in both hemispheres. The median and quartile deviation (QD) of these values were individually calculated. Within the 20 individuals, the mean QD of TPI was 0.68 s, and there was no case in which any TPI exceeded the mean more than 2 s. With PW, the mean QD was 1.2 s, and the mean was not exceeded by more than 6 s. Intraindividual perfusion parameters, especially TPI, show a considerable small range. Thus, the bolus kinetic derives reliable semiquantitative information once intraindividual comparison can be accomplished. We therefore propose that bilateral examination with the unaffected hemisphere as referential region should be performed in acute stroke. Future studies have to evaluate the potential of this approach of discriminating ischemia and hypoperfusion in the affected hemisphere.

Validation of the depletion kinetic in semiquantitative ultrasonographic cerebral perfusion imaging using 2 different techniques of data acquisition.

OBJECTIVE: To validate the potential of ultrasonographic depletion imaging for semiquantitatively visualizing cerebral parenchymal perfusion with contrast burst depletion imaging (CODIM) in comparison with phase inversion harmonic depletion imaging (PIDIM) in healthy volunteers. METHODS: Thirteen healthy adults were examined with both CODIM and PIDIM in accordance with previously described criteria. In addition to the perfusion coefficient, the time to decrease image intensity to 10% above equilibrium intensity from the initial value and the relative error (deviation of measured data from the fitted model) were evaluated to compare the reliability of both techniques in 3 different regions of interest. RESULTS: Perfusion coefficient values did not show significantly differing values in both groups (1.57-1.64 * 10(-2) s(-1) for CODIM and 1.42-1.58 * 10(-2) s(-1) for PIDIM). The relative error was significantly smaller in the PIDIM group (0.38-0.53 for CODIM and 0.18-0.25 for PIDIM; P < .002). CONCLUSIONS: Phase inversion harmonic depletion imaging proved to be more reliable than CODIM because values of the relative error were significantly lower in PIDIM even in this relatively small cohort. This is of interest because the underlying technique, phase inversion harmonic imaging, is more widely available than contrast burst imaging.

Reliability of semiquantitative ultrasonic perfusion imaging of the brain.

BACKGROUND AND PURPOSE: Contrast burst depletion imaging (CODIM) visualizes cerebral perfusion by destruction of microbubbles and observation of image intensity course. Because of its complexity, artifacts occur. Criteria of reliability to improve diagnostic significance were created and validated. METHODS AND RESULTS: Eighteen healthy volunteers were examined with 2 echo contrast agents (ECAs) and 3 frame rates in 3 regions of interest (ROIs). Perfusion coefficient (PC), Tmin (time to decrease intensity to 10% of its max), and relative error (RE) (deviation of measured data from fitted model) were determined. PC differed significantly neither between CA nor between frame rates (overall mean = 1.60 +/- 0.21 x 10(-2) s-1). Tmin differed significantly between frame rate groups (P < .001, 33.4 +/- 11.2 s/0.5 Hz; 3.6 +/- 2.5 s/5 Hz) since it is related to destruction of microbubbles that occurs with each frame and to the perfusion rate. RE was higher in the Optison group and tended to decrease in ROIs closer to the probe. CONCLUSIONS: PC was independent of frame rate and ECA. Tmin was shorter with higher frame rates. Due to a very rapid decay at 5 Hz, the ideal frame rate should be about 1 Hz, that is, because the number of frames acquired within Tmin and therefore signal-to-noise ratio is higher at 1 Hz. Since the algorithm is complex (high RE) and more artifacts should occur in patients (insufficient bone window, etc), a triggering of the insonations by, for example, heart rate could decrease artifacts and increase diagnostic power of CODIM.

Parameters of cerebral perfusion in phase-inversion harmonic imaging (PIHI) ultrasound examinations.

The aim was to evaluate phase-inversion harmonic imaging (PIHI) with respect to brain perfusion imaging using a novel "bilateral approach" (depth of examination: 150 mm) and established unilateral approach (100 mm). After bolus injection of two contrast agents (CA, Optison and SonoVue), perfusion-related parameters (time-to-peak intensity, Itpk, peak intensity, Ipk, and peak width, Wpk) were extracted by fitting a model function to time-intensity curves for different regions-of-interest (ROI) in 14 volunteers. In 207 (92%) of 224 ipsilateral ROIs and in 165 (98%) of 168 contralateral ROIs (372 or 95% of 392 altogether), parameters could be derived. Itpk and Wpk of gray matter ROIs did not vary in or between both CA groups (18.1-21.9 s and 7.9-14.2 s). ROIs within arteries showed significantly shorter Itpk (16.1-16.7 s) and longer Wpk (12.8-28.3 s). Level of significance was 0.05 (two-sided). Newer CAs are usable for nonlinear imaging over a wider range of acoustic intensities, so that sensitivity of PIHI is sufficient to image the brain bilaterally. This approach proves to be reliable in patients with adequate bone windows. For acute stroke patients, this implies that both hemispheres can be compared in one instead of two examinations, reducing time of examination by 50%. Furthermore, evaluation of regions close to the probe becomes possible. Thus, the "bilateral approach" should be considered as a new standard approach of acute ultrasonic perfusion imaging.

Brain perfusion imaging of a craniopharyngioma by transcranial duplex sonography.

BACKGROUND AND PURPOSE: The aim of this study was to test a new ultrasound software tool to assess pathological perfusion in a brain tumor patient. METHODS: Tissue harmonic imaging (THI) enables an improved depiction of brain morphology, employing nonlinear parenchyma and ultrasound contrast agent (UCA) backscatter information. With specialized software, morphological information can be separated from perfusion information. Both can be superimposed at a preferred mixing ratio in a single image. RESULTS: Using THI and a perfluoropropane-based UCA, a pathologic perfusion pattern described by abnormal perfused areas in the tumor region could be demonstrated. After superimposing morphologic and perfusion information, subtle structural tumor inhomogeneities were depicted. Craniopharyngioma structure and perfusion defect were confirmed by T2-weighted and perfusion-weighted magnetic resonance imaging. CONCLUSION: Transcranial duplex sonography in combination with contrast specific imaging methods might be helpful to visualize perfusion defects without loss of morphological information.

Contrast burst depletion imaging (CODIM): a new imaging procedure and analysis method for semiquantitative ultrasonic perfusion imaging.

BACKGROUND AND PURPOSE: Established methods of ultrasonic perfusion imaging using a bolus application of echo contrast agent provide only qualitative data because of various physical phenomena. This study was intended to investigate whether a new ultrasound perfusion imaging method termed contrast burst depletion imaging (CODIM) may provide semiquantitative measures of parenchymal perfusion independent of examination depth and acoustic energy distribution. METHODS: In a system with a constant concentration of contrast agent, analyzing the decrease in image intensity that occurs with microbubble-destructive imaging modes yields parameters that are considered to correlate with tissue perfusion. This method was first evaluated with a perfusion model that showed that the main resulting parameter "perfusion coefficient" (PC) is a monotonic nonlinear function of flow velocity. Seventeen human volunteers were then scanned according to this method with the use of 2 different contrast agents. Results were correlated with those from perfusion-weighted MRI examinations. RESULTS: The PC did not show significant differences in gray matter areas (ranging from 1.466x10(-2) x s(-1) to 1.641x10(-2) x s(-1)) of the brain despite different insonation depths (eg, ipsilateral and contralateral thalamus). In contrast, white matter exhibited significantly lower perfusion values in both imaging modes (PC: 0.604x10(-2) x s(-1) to 0.745x10(-2) x s(-1); P<0.05). CONCLUSIONS: CODIM is a promising new tool of imaging parenchymal (brain) perfusion in healthy persons. The method provides semiquantitative and depth-independent perfusion parameters and in this way overcomes the limitations of the perfusion methods using a bolus kinetic. Further investigations must be done to evaluate the potential of the method in patients with perfusion deficits.

Brain perfusion and ultrasonic imaging techniques.

Advances in neurosonology have generated several techniques of ultrasonic perfusion imaging employing ultrasound echo contrast agents (ECAs). Doppler imaging techniques cannot measure the low flow velocities that are associated with parenchymal perfusion. Ultrasonic perfusion imaging, therefore, is a combination of a contrast agent-specific ultrasound imaging technique (CAI) mode and a data acquisition and processing (DAP) technique that is suited to observe and evaluate the perfusion kinetics. The intensity in CAI images is a measure of ECA concentration but also depends on various other parameters, e.g. depth of examination. Moreover, ECAs can be destroyed by ultrasound, which is an artifact but can also be a feature. Thus, many different DAPs have been developed for certain CAI techniques, ECAs and target organs. Although substantial progress in ECA and CAI technology can be foreseen, ultrasound contrast imaging has yet to reliably differentiate between normal and pathological perfusion conditions. Destructive imaging techniques, such as contrast burst imaging (CBI) or time variance imaging (TVI), in combination with new DAP techniques provide sufficient signal-to-noise ratio (SNR) for transcranial applications, and consider contrast agent kinetics and destruction to eliminate depth dependency and to calculate semi-quantitative parameters. Since ultrasound machines are widely accessible and cost-effective, ultrasonic perfusion imaging techniques should become supplementary standard perfusion imaging techniques in acute stroke diagnosis and monitoring. This paper gives an overview on different CAI and DAP techniques with special focus on recent innovations and their clinical potential.

Comparison between echo contrast agent-specific imaging modes and perfusion-weighted magnetic resonance imaging for the assessment of brain perfusion.

BACKGROUND AND PURPOSE: Contrast burst imaging (CBI) and time variance imaging (TVI) are new ultrasonic imaging modes enabling the visualization of intravenously injected echo contrast agents in brain parenchyma. The aim of this study was to compare the quantitative ultrasonic data with corresponding perfusion-weighted MRI data (p-MRI) with respect to the assessment of brain perfusion. METHODS: Twelve individuals with no vascular abnormalities were examined by CBI and TVI after an intravenous bolus injection of 4 g galactose-based microbubble suspension (Levovist) in a concentration of 400 mg/mL. Complementary, a dynamic susceptibility contrast MRI, ie, p-MRI, of each individual was obtained. In both ultrasound (US) methods and p-MRI, time-intensity curves were calculated offline, and absolute time to peak intensities (TPI), peak intensities (PI), and peak width (PW) of US investigations and TPI, relative cerebral blood flow (CBF) and relative cerebral blood volume (CBV) of p-MRI examinations were determined in the following regions of interest (ROIs): lentiform nucleus (LN), white matter (WM), posterior (PT), and anterior thalamus (AT). In addition, the M(2) segment of the middle cerebral artery (MCA) was evaluated in the US, and the precentral gyrus (PG) was examined in the p-MRI examinations. In relation to a reference parenchymal ROI (AT), relative TPIs were compared between the US and p-MRI methods and relative PI of US investigations with the ratio of CBF (rCBF) of p-MRI examinations in identical ROIs. RESULTS: Mean TPIs varied from 18.3+/-5.0 (AT) to 20.1+/- 5.8 (WM) to 17.2+/-4.9 (MCA) seconds in CBI examinations and from 19.4+/-5.3 (AT) to 20.4+/-4.3 (WM) to 17.3+/-4.0 (MCA) seconds in TVI examinations. Mean PIs were found to vary from 581.9+/-342.4 (WM) to 1522.9+/-574.2 (LN) to 3400.9+/- 621.7 arbitrary units (MCA) in CBI mode and from 7.5+/-4.6 (WM) to 17.5+/-4.9 (LN) to 46.3+/-7.1 (MCA) arbitrary units in TVI mode. PW ranged from 7.3+/-4.5 (AT) to 9.1+/-4.0 (LN) to 24.3+/-12.8 (MCA) seconds in CBI examinations and from 7.1+/-3.9 (AT) to 8.7+/-3.5 (LN) to 26.7+/-18.2 (MCA) seconds in TVI examinations. Mean TPI was significantly shorter and mean PI and mean PW were significantly higher in the MCA compared with all other ROIs (P<0.05). Mean TPI of the p-MRI examinations ranged from 22.0+/-6.9 (LN) to 23.0+/-6.8 (WM) seconds; mean CBF ranged from 0.0093+/- 0.0041 (LN) to 0.0043+/-0.0021 (WM). There was no significant difference in rTPI in any ROI between US and p-MRI measurements (P>0.2), whereas relative PIs were significantly higher in areas with lower insonation depth such as the LN compared with rCBF. CONCLUSIONS: In contrast to PI, TPI and rTPI in US techniques are robust parameters for the evaluation of cerebral perfusion and may help to differentiate physiological and pathological perfusion in different parenchymal regions of the brain.