Sonographic parenchymal and brain perfusion imaging: preliminary results in four patients following decompressive surgery for malignant middle cerebral artery infarct.
To investigate new methods of diagnostic transcranial sonography for brain parenchymal, vascular and perfusion imaging, we performed 3-D native tissue harmonic transcranial sonography (3D-nthTCS), 3-D transcranial color-coded duplex sonography (3D-TCCS), and "loss-of-correlation" imaging (LOC-TCCS) in four patients following early hemicraniectomy due to space-occupying "malignant" middle cerebral artery infarction (MMCAI). Three-dimensional datasets, utilizing 3D-nthTCS and 3D-TCCS, were created and up to 10 axial 2-D B-mode image planes, similar to CCT, reconstructed in each patient. Three-dimensional reconstructions of the circle of Willis documented one persistent carotid-T occlusion and three recanalizations of the MCA. LOC-TCCS, based on stimulated acoustic emission from an ultrasound (US) contrast agent, demonstrated a perfusion deficit in 2 of 3 patients, with regard to their infarcts. Concluding, 3D-nthTCS, 3D-TCCS and LOC-TCCS are promising tools for bedside monitoring, early prognosis and treatment evaluation for MMCAI in the postoperative period. Further studies should be performed to standardize these new methods and evaluate their applications through the intact calvarina.
Schlachetzki
F
F
Department of Neurology, University of Regensburg, Regensburg, Germany. felix.schlachetzki@klinik.uni-regensburg.de
Hoelscher
T
T
Dorenbeck
U
U
Greiffenberg
B
B
Marienhagen
J
J
Ullrich
O W
OW
Bogdahn
U
U
D000328:Adult; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000601:surgery; D002560:Cerebrovascular Circulation; D003287:Contrast Media / Q000008:administration & dosage; D003399:Craniotomy; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000008:administration & dosage; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508