Value of ultrasound fusion imaging in detecting vascular cerebral white matter pathology.

BACKGROUND: Transcranial sonography is beside magnetic resonance imaging (MRI) and computed tomography, a well-established imaging method for evaluation of brain parenchyma and already implicated in various neurological disorders as bed-side investigation possibility in clinical routine. The aim of this study was the qualitative assessment detecting vascular white matter hyperintensities (WMHs), with ultrasound fusion-imaging technique (UFI) and to find the optimal location for their visualization in accordance to the grade of WMHs and to possibly providing a standardized protocol for clinical use. RESULTS: 29 patients with WMHs of variable degree quantified according to Fazekas grading scale (n = 13 I; n = 9 II; n = 7 III) and 11 subjects with normal findings on MRI were identified for further analysis. Ultrasound images were analyzed to a standardized protocol and predefined anatomical landmarks. UFI could visualize the MRI-verified WMHs in 147 of 161 localizations (91%). The overall ultrasound detection rate of WMHs increased with higher degree of WMHs burden (I:85%, II:94%, III:97%). The highest sensitivity was achieved at the contralateral central part (CPc) (97%) of the lateral ventricle. The inter-rater analysis between 2 independent raters, who were blinded to the patient's diagnosis and assessed only the B-mode ultrasound images, indicated an 86% agreement with an overall moderate strength of agreement (κ: 0.489, p < 0.0005) for all localizations. The highest accordance within raters was shown at the CPc; 92% (κ: 0.645, p < 0.0005). CONCLUSIONS: This explorative study describes prospectively the ultrasound detection of periventricular vascular WMHs based on MRI lesions using UFI. Transcranial ultrasound (TCS) could serve as an additional screening opportunity for the detection of incidental WMLs during routine TCS investigations to initiate early vascular risk factor modification in primary prevention.

Cerebral autoregulation and brain networks in occlusive processes of the internal carotid artery.

Patients with unilateral occlusive processes of the internal carotid artery (ICA) show subtle cognitive deficits. Decline in cerebral autoregulation and in functional and structural integrity of brain networks have previously been reported in the affected hemisphere (AH). However, the association between cerebral autoregulation, brain networks, and cognition remains to be elucidated. Fourteen neurologically asymptomatic patients (65±11 years) with either ICA occlusion or high-grade ICA stenosis and 11 age-matched healthy controls (HC) (67±6 years) received neuropsychologic testing, transcranial Doppler sonography to assess cerebral autoregulation using vasomotor reactivity (VMR), and magnetic resonance imaging to probe white matter microstructure and resting-state functional connectivity (RSFC). Patients performed worse on memory and executive tasks when compared with controls. Vasomotor reactivity, white matter microstructure, and RSFC were lower in the AH of the patients when compared with the unaffected hemisphere and with controls. Lower VMR of the AH was associated with several ipsilateral clusters of lower white matter microstructure and lower bilateral RSFC in patients. No correlations were found between VMR and cognitive scores. In sum, impaired cerebral autoregulation was associated with reduced structural and functional connectivity in cerebral networks, indicating possible mechanisms by which severe unilateral occlusive processes of the ICA lead to cognitive decline.

Dopplersonographic measurement of global cerebral circulation time using echo contrast-enhanced ultrasound in normal individuals and patients with arteriovenous malformations.

Echo-contrast "bolus tracking" by ultrasound (US) is an exciting new tool to study cerebral haemodynamics. In the present study, a global cerebral circulation time (CCT) was measured by extracranial Doppler as the time difference of contrast bolus arrival between the internal carotid artery and internal jugular vein. A total of 64 healthy volunteers and 9 patients with an angiographically diagnosed arteriovenous malformation (AVM) were studied. CCT in volunteers and patients was calculated as the time interval between the points of 10% rise (CCT(1)) and 90% rise (CCT(3)) of the total intensity increase and between the turning points (CCT(2)) of the resulting time-intensity curves. In the volunteer group, CCT(1) was 5.4 +/- 1.8 s, CCT(2) was 7 +/- 1.3 s and CCT(3) 7.5 +/- 1.8 s. CCT results in the AVM group were 2.8 +/- 2.5 s, 3.0 +/- 1.3 s and 4.5 +/- 2.1 s, respectively, and differed significantly from the controls. For the first time, we could confirm a significant shortening of CCT in patients with cerebral AVM by US. The presented test might become a new, additional tool for AVM evaluation and follow-up of treatment in these patients.

Measurement of global cerebral circulation time using power duplex echo-contrast bolus tracking.

Ultrasound assessment of global cerebral circulation time (CCT) using echo-contrast bolus tracking is a new approach to characterise the perfusion status of the human brain. We present the analysis of global CCT in 36 healthy volunteers and one patient with a cerebral arteriovenous malformation (AVM), measured by extracranial power duplex. CCT was defined as the time interval between bolus arrival in the internal carotid artery and internal jugular vein. CCT in the volunteer group was 7.5 +/- 1.1 s (mean +/- SD). Values did not correlate with age, gender, blood pressure or blood flow velocity. Measurement in the AVM patient revealed a CCT of 1.5 s. Ultrasonographic CCT analysis is a promising new tool for the evaluation of cerebral hemodynamics.