Harmonic imaging of the human brain - Visualization of brain perfusion with ultrasound

Background and Purpose-Through harmonic gray-scale imaging, it is possible to analyze brain tissue perfusion with different ultrasound methods. Methods-In 12 healthy volunteers, 2 doses (0.5 and 1.5 mL) of Optison, a perfluoropropane-containing contrast agent, were injected intravenously and produced a strong increase of brightness in the brain parenchyma. We used harmonic imaging for quantification of ultrasound intensity in the thalamus, ipsilateral temporoparietal white matter (TPWM), and ipsilateral lateral fissure at both sides. Time-intensity curves were calculated, and peak increase (PI) of intensity and the area under the time-intensity curve (AUC) from baseline were compared. Results-We found a significant dose dependence of the AUC in all regions at both sides. PI only showed a significant dose dependence in the TPWM but not in the ipsilateral thalamus and lateral fissure. No side differences for AUC and PI were detected in all regions and doses used. We found a significantly higher value of the PI insonating the thalamus from the ipsilateral side compared with the contralateral side. The same result was obtained for the AUC in the left thalamus for both doses and in the right thalamus for the high dose. Using 0.5 mL for insonation of the right thalamus AUC again showed a higher value for the insonation from the ipsilateral compared with the contralateral side but failed to show statistical significance (P=0.08, n=12). Conclusions-Harmonic gray-scale imaging with Optison showed a strong enhancement effect in the brain parenchyma. A quantitative analysis of perfusion seems difficult because of the depth dependence of the effect. The most robust parameter is the AUG.