title: Contrast-Enhanced Ultrasound Imaging in Detection of Changes in Cerebral Perfusion.
abstract: Contrast-enhanced ultrasonography (CEU) is a non-invasive imaging technique that provides real-time, bedside information on changes in global and segmental organ perfusion. Currently, there is a lack of data concerning changes in the distribution of segmental brain perfusion in acute ischemic stroke treated by decompressive craniectomy. The aim of our case series was to assess the role of CEU after decompressive craniectomy in patients with acute ischemic stroke. CEU was performed in 12 patients at baseline and after any one of the following interventions was performed as dictated by the patient's clinical condition: vasoactive drug administration (in order to achieve cerebral perfusion pressure ≥70 mm Hg and mean arterial pressure <100 mm Hg for management of arterial blood pressure) and mild hyperventilation (carbon dioxide arterial pressure = 30-35 mm Hg). CEU was able to detect a significant variation in cerebral contrast distribution in both normal and pathologic hemispheres after induced hyperventilation (difference in time to peak [dTTP] = -38.4%), vasodilation (dTTP = -6.6%) and vasoconstriction (dTTP = +31.2%) (p < 0.05). CEU can be useful in assessing real-time cerebral perfusion changes in neurocritical care patients.
authors.affiliation: Department of Anesthesiology, University of Rome "Sapienza", Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Bilotta
authors.affiliation: Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom. Electronic address: kiarobba@gmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: Robba
authors.affiliation: Department of Neurosurgery, University of Rome "Sapienza", Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Department of Neurosurgery, University of Rome "Sapienza", Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Delfini
authors.affiliation: Department of Anesthesiology, University of Rome "Sapienza", Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rosa
authors.affiliation: Department of Cardiology, University of Rome "Sapienza", Rome, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Agati
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Brain perfusion; Contrast ultrasound imaging; Decompressive craniectomy; Intra-cranial pressure