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Transcranial Contrast Imaging of Cerebral Perfusion in Patients With Space-Occupying Intracranial Lesions

Department of Clinical Neurophysiology, Georg-August-University Göttingen, Göttingen, Germany (E.B.); and Department of Neurology, Hospital Lippoldsberg, Wahlsburg, Germany (H.-J.B.).

Address correspondence to Eva Bartels, MD, PhD, Department of Clinical Neurophysiology, Georg-August-University Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany. E-mail: bartels.eva{at}t-online.de

Objective. The aim of this study was to evaluate a deficit in cerebral perfusion after administration of the contrast agent SonoVue (Bracco Altana Pharma, Konstanz, Germany) in patients with intracranial space-occupying lesions. Methods. We used transcranial duplex sonography to examine 10 healthy volunteers and 4 patients. Of the patients, one 55-year-old woman had an intracranial glioblastoma; one 54-year-old woman had an intracranial hemorrhage; and one 49-year-old woman and one 69-year-old man had a malignant middle cerebral artery infarction. A decompressive craniectomy was performed in the 2 patients with malignant middle cerebral artery infarction. Triggered images with pulsing intervals of 1000 milliseconds were used for the evaluation of time-intensity curves in several regions of interest. The mechanical index was set at 1.6; in patients with a craniectomy, the mechanical index was set at 1.1. Results. In all patients, the perfusion deficit could be recognized in the ipsilateral hemisphere. The superimposition of the sonographic images with those from computed tomography or magnetic resonance imaging showed a good correspondence in shape and size in patients with a craniectomy. In patients without a craniectomy, a rough correspondence with findings from magnetic resonance imaging or computed tomography could be recognized. Conclusions. By using contrast-enhanced transcranial duplex sonography, it is possible to image the perfusion deficit in cerebral microcirculation in patients with intracranial space-occupying lesions. These results should be confirmed by more pathologic cases and correlated with magnetic resonance imaging and other neuroimaging techniques. Additionally, further technical development in sonographic systems is necessary to improve the diagnostics of cerebral perfusion deficit.

Key Words: cerebral perfusion • cerebral perfusion deficit • contrast media • native tissue harmonic imaging • space-occupying lesion • stroke • transcranial duplex sonography

Abbreviations: CT, computed tomography • MCA, middle cerebral artery • MI, mechanical index • MRI, magnetic resonance imaging

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