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(Stroke. 2003;34:77.)
© 2003 American Heart Association, Inc.

Original Contributions

Contrast Burst Depletion Imaging (CODIM)

A New Imaging Procedure and Analysis Method for Semiquantitative Ultrasonic Perfusion Imaging

Jens Eyding, MD; Wilko Wilkening, Dipl-Ing (MSc); Markus Reckhardt, MD; Gebhard Schmid, MD; Saskia Meves, MD; Helmut Ermert, PhD; Horst Przuntek, MD Thomas Postert, MD

From the Departments of Neurology (J.E., M.R., S.M., H.P., T.P.), Electrical Engineering (W.W., H.E.), and Radiology (G.S.), Ruhr University Bochum, Bochum, Germany.

Correspondence to Dr Jens Eyding, Neurologische Klinik der Ruhr-Universität, St Josef Hospital, Gudrunstrasse 56, D-44791 Bochum, Germany. E-mail jeyding{at}web.de

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 s^-1 to 1.641x10^-2 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 s^-1 to 0.745x10^-2 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.

Key Words: cerebrovascular circulation • magnetic resonance imaging • perfusion • ultrasonography

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