Relationship between refill-kinetics of ultrasound perfusion imaging and vascular obstruction in acute middle cerebral artery stroke

Manuel Bolognese, Dimitrios Artemis, Angelika Alonso, Michael G. Hennerici, Stephan Meairs, R. Rolf Kern
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Abstract

Background

Ultrasound perfusion imaging (UPI) with bolus kinetic has been shown to be feasible at bedside for evaluation of perfusion deficits in stroke patients. Recent technical advances allow perfusion imaging with refill kinetics using a low mechanical index.

Methods

We examined 31 acute middle cerebral artery (MCA) stroke patients with transcranial color-coded duplex ultrasound (TCCD) and UPI. The refill of microbubbles was calculated from regions of interest in the ischemic area and the contralateral MCA territory by using the exponential function y = A(1  eβt); A = acoustic intensity of the plateau (dB), β = slope (1/s).

Results

We found significantly lower values of β in the ischemic area compared with the contralateral MCA territory (0.75 vs. 1.05 1/s, p < 0.05); particularly in patients with a pathological MCA flow pattern on TCCD (0.61 vs. 1.01, p < 0.01). There was a high interindividual variance without significant difference of the plateau of acoustic intensity (A) in any subgroup of patients.

Discussion

The slope parameter β of refill kinetics is useful for assessing brain perfusion in patients with acute stroke and pathological flow pattern of the ipsilateral MCA. The parameter A, however, seems more dependent from the quality of the temporal bone window.

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急性脑中动脉卒中超声灌注显像再灌注动力学与血管阻塞的关系
超声灌注成像(UPI)与动力丸已被证明是可行的床边评估灌注缺陷的脑卒中患者。最近的技术进步允许灌注成像与再灌注动力学使用低机械指数。方法应用经颅彩色编码双工超声(TCCD)和UPI对31例急性大脑中动脉(MCA)脑卒中患者进行检查。利用指数函数y = A(1−eβt)从缺血区域和对侧MCA区域的感兴趣区域计算微泡的重新填充;A =高原声强(dB), β =坡度(1/s)。结果与对侧MCA区相比,缺血区β值明显降低(0.75 vs 1.05 1/s, p <0.05);特别是在TCCD上有病理性MCA血流模式的患者中(0.61 vs. 1.01, p <0.01)。各亚组患者的声强平台(a)存在较高的个体间差异,但差异无统计学意义。再灌注动力学斜率参数β可用于评估急性脑卒中患者的脑灌注和同侧MCA的病理血流模式。然而,参数A似乎更依赖于颞骨窗的质量。
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