From the Department of Neurology, Ruhr-University Bochum (Germany).
Correspondence to Dr Thomas Postert, Department of Neurology, St Josef Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791 Bochum, Germany.
Background and
Purpose—Gray-scale harmonic imaging is the first method to
visualize blood perfusion and capillary blood flow with ultrasound
after intravenous contrast agent application. The purpose
of the present study was to evaluate the potential of transient
response second harmonic imaging (TRsHI) to assess normal echo contrast
characteristics in different brain areas by transcranial
ultrasound.
Methods—In 18 patients without cerebrovascular diseases, TRsHI
examinations were performed bilaterally with the use of the
transtemporal approach after application of 6.5 mL of a
galactose-based microbubble suspension (400 mg/mL). The transmission
rate was once every 4 cardiac cycles. Regional cerebral contrast was
visually assessed and then quantified off-line with the use of
time-intensity curves. In 4 different regions of interest (ROI)
(posterior part of the thalamus [ROIa], anterior part of the thalamus
[ROIb], lentiform nucleus [ROIc], and white matter [ROId]), the
following parameters were evaluated: peak intensity, area
under the curve (AUC), and time to peak intensity. AUC ratios for
ROIc/a, d/a, c/b, and d/b were calculated.
Results—In all patients parenchymal contrast enhancement was
visually detectable. One hundred thirty-one characteristic
time-intensity curves (baseline phase, peak contrast intensity, slow
washout phase) were demonstrable in 144 ROIs. In ROIc and ROId,
characteristic contrast curves could be observed most frequently (68/72
examinations), whereas time-intensity curves in ROIa and ROIb could not
be evaluated because of inadequate contrast enhancement in 9 of 72
examinations. Time to peak intensity varied between 20 and 52 cardiac
cycles; in 1 patient it was 88 cardiac cycles. In all individuals AUCs
and in 16 of 18 subjects peak intensity in ROIc and ROId showed
a 2- to 10-fold increase compared with ROIa and ROIb. In no examination
did AUC ratios show a >2-fold side difference irrespective of the
ROI.
Conclusions—The present study demonstrates for the first time
that TRsHI produces accurate contrast in different brain areas and
represents an ultrasonic tool related to brain perfusion.
Absolute values of quantitative parameters show high
variations caused by different temporal bone thicknesses and a complex
relationship between echo contrast concentrations and measurements of
optic intensities. Ratios between different ROIs help to compare
contrast enhancement in different brain areas. Furthermore, because of
the fact that attenuation of contrast enhancement in TRsHI depends
strictly on the insonation depth, harmonic imaging studies of brain
perfusion cannot be compared directly with other imaging techniques
such as positron emission tomography.
© 1998 American Heart Association, Inc.
Original Contributions
Transient Response Harmonic Imaging
An Ultrasound Technique Related to Brain Perfusion
Key Words: echocardiography • imaging, harmonic • imaging, transient response • perfusion, brain • ultrasonography, Doppler, transcranial
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