title: Is ultrasound perfusion imaging capable of detecting mismatch? A proof-of-concept study in acute stroke patients.
abstract: In this study, we compared contrast-enhanced ultrasound perfusion imaging with magnetic resonance perfusion-weighted imaging or perfusion computed tomography for detecting normo-, hypo-, and nonperfused brain areas in acute middle cerebral artery stroke. We performed high mechanical index contrast-enhanced ultrasound perfusion imaging in 30 patients. Time-to-peak intensity of 10 ischemic regions of interests was compared to four standardized nonischemic regions of interests of the same patient. A time-to-peak >3 s (ultrasound perfusion imaging) or >4 s (perfusion computed tomography and magnetic resonance perfusion) defined hypoperfusion. In 16 patients, 98 of 160 ultrasound perfusion imaging regions of interests of the ischemic hemisphere were classified as normal, and 52 as hypoperfused or nonperfused. Ten regions of interests were excluded due to artifacts. There was a significant correlation of the ultrasound perfusion imaging and magnetic resonance perfusion or perfusion computed tomography (Pearson's chi-squared test 79.119, p < 0.001) (OR 0.1065, 95% CI 0.06-0.18). No perfusion in ultrasound perfusion imaging (18 regions of interests) correlated highly with diffusion restriction on magnetic resonance imaging (Pearson's chi-squared test 42.307, p < 0.001). Analysis of receiver operating characteristics proved a high sensitivity of ultrasound perfusion imaging in the diagnosis of hypoperfused area under the curve, (AUC = 0.917; p < 0.001) and nonperfused (AUC = 0.830; p < 0.001) tissue in comparison with perfusion computed tomography and magnetic resonance perfusion. We present a proof of concept in determining normo-, hypo-, and nonperfused tissue in acute stroke by advanced contrast-enhanced ultrasound perfusion imaging.
authors.affiliation: 1 Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Raluca
authors.initials: R
authors.lastname: Reitmeir
authors.affiliation: 2 Department of Neurology, University Hospital, Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Eyding
authors.affiliation: 1 Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Markus F
authors.initials: MF
authors.lastname: Oertel
authors.affiliation: 3 Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Wiest
authors.affiliation: 3 Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.affiliation: 4 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.affiliation: 5 ARTORG Center for Biomedical Engineering, University of Bern, Switzerland.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Giquel
authors.affiliation: 5 ARTORG Center for Biomedical Engineering, University of Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Weber
authors.affiliation: 1 Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.affiliation: 4 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.affiliation: 1 Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Werner J
authors.initials: WJ
authors.lastname: Z'Graggen
authors.affiliation: 1 Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
mesh_terms: D000208:Acute Disease; D000368:Aged; D000465:Algorithms; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography / Q000379:methods* / Q000592:standards; D008297:Male; D012680:Sensitivity and Specificity; D012984:Software; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods* / Q000592:standards
chemical_list: D003287:Contrast Media
keywords: Acute ischemic stroke; brain imaging; cerebral perfusion; neurosonology; ultrasound perfusion imaging