Cerebral perfusion in a high-grade glioma evaluated with sonographic contrast pulse sequencing technology

Transcranial duplex sonography with contrast harmonic imaging is an emerging tool for evaluating brain perfusion. The development of new techniques and software provides more and more reliable and noninvasive information. The most common application of this method has been in the field of cerebrovascular disease. Brain tumor perfusion and metabolism have largely been studied with several neuroimaging techniques to determine malignancy, whereas the study of brain tumor perfusion with transcranial duplex sonography and sonographic contrast agents is still a field to be discovered, with few published reports to date. In a recent paper, Bartels and Bittermann(1) observed a brain perfusion deficit in 4 patients with space-occupying lesions: 1 affected by glioblastoma, 1 by hemorrhage, and 2 by malignant middle cerebral artery infarction. In the patient with the temporal glioblastoma, the authors observed a perfusion deficit in the tumor area with new contrast pulse sequencing (CPS) software developed by Siemens Medical Solutions (Erlangen, Germany). We report the case of a histologically proven high-grade glioma evaluated with CPS imaging compared with perfusion-weighted magnetic resonance imaging.