Real-Time Ultrasound Brain Perfusion Imaging with Analysis of Microbubble Replenishment in Acute MCA Stroke
Real-time ultrasound perfusion imaging (rt-UPI) allows visualization of microbubbles flowing through the cerebral microvasculature. We hypothesized that analysis of microbubble tissue replenishment would enable for characterization of perfusion deficits in acute middle cerebral artery (MCA) territor...
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| Veröffentlicht in: | Journal of cerebral blood flow and metabolism 2011-08, Vol.31 (8), p.1716-1724 |
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| container_title | Journal of cerebral blood flow and metabolism |
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| creator | Kern, Rolf Diels, Anna Pettenpohl, Johanna Kablau, Micha Brade, Joachim Hennerici, Michael G Meairs, Stephen |
| description | Real-time ultrasound perfusion imaging (rt-UPI) allows visualization of microbubbles flowing through the cerebral microvasculature. We hypothesized that analysis of microbubble tissue replenishment would enable for characterization of perfusion deficits in acute middle cerebral artery (MCA) territory stroke. Twenty-three patients (mean age 70.2 ± 13.2 years, 9 weeks) were included. Sequential images of bubble replenishment were acquired by transcranial rt-UPI at low mechanical index immediately after microbubble destruction. Different parameters were calculated from regions of interest (ROIs): real-time time to peak (rt-TTP), rise rate (β), and plateau (A) of acoustic intensity, and A×β was used as an index of blood flow. Results were compared with diffusion-weighted and perfusion magnetic resonance imaging. Parameters of rt-UPI had lower values in ROIs of ischemic as compared with normal tissue (β = 0.58 ± 0.40 versus 1.25 ± 0.83; P = 0.001; A = 1.44 ± 1.75 versus 2.63 ± 2.31; P = 0.05; A×β = 1.14 ± 2.25 versus 2.98 ± 2.70; P = 0.01). Real-time time to peak was delayed in ischemic tissue (11.43 ± 2.67 versus 8.88 ± 1.66 seconds; P < 0.001). From the analysis of receiver operating characteristic curves, β and A×β had the largest areas under the curve with optimal cutoff values of β < 0.76 and A×β < 1.91. We conclude that rt-UPI with analysis of microbubble replenishment correctly identifies ischemic brain tissue in acute MCA stroke. |
| doi_str_mv | 10.1038/jcbfm.2011.14 |
| format | Article |
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We hypothesized that analysis of microbubble tissue replenishment would enable for characterization of perfusion deficits in acute middle cerebral artery (MCA) territory stroke. Twenty-three patients (mean age 70.2 ± 13.2 years, 9 weeks) were included. Sequential images of bubble replenishment were acquired by transcranial rt-UPI at low mechanical index immediately after microbubble destruction. Different parameters were calculated from regions of interest (ROIs): real-time time to peak (rt-TTP), rise rate (β), and plateau (A) of acoustic intensity, and A×β was used as an index of blood flow. Results were compared with diffusion-weighted and perfusion magnetic resonance imaging. Parameters of rt-UPI had lower values in ROIs of ischemic as compared with normal tissue (β = 0.58 ± 0.40 versus 1.25 ± 0.83; P = 0.001; A = 1.44 ± 1.75 versus 2.63 ± 2.31; P = 0.05; A×β = 1.14 ± 2.25 versus 2.98 ± 2.70; P = 0.01). Real-time time to peak was delayed in ischemic tissue (11.43 ± 2.67 versus 8.88 ± 1.66 seconds; P < 0.001). From the analysis of receiver operating characteristic curves, β and A×β had the largest areas under the curve with optimal cutoff values of β < 0.76 and A×β < 1.91. We conclude that rt-UPI with analysis of microbubble replenishment correctly identifies ischemic brain tissue in acute MCA stroke.</description><identifier>ISSN: 0271-678X</identifier><identifier>EISSN: 1559-7016</identifier><identifier>DOI: 10.1038/jcbfm.2011.14</identifier><identifier>PMID: 21364598</identifier><identifier>CODEN: JCBMDN</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Acoustics ; Age ; Biological and medical sciences ; Brain ; Brain - blood supply ; Brain Ischemia - physiopathology ; Cerebral blood flow ; Infarction, Middle Cerebral Artery - diagnostic imaging ; Infarction, Middle Cerebral Artery - physiopathology ; Investigative techniques, diagnostic techniques (general aspects) ; Ischemia ; Magnetic Resonance Imaging ; Medical sciences ; Microbubbles ; Microcirculation - physiology ; Microvasculature ; Nervous system ; Neuroimaging ; Neurology ; Original ; Perfusion ; Perfusion Imaging - methods ; ROC Curve ; Stroke ; Territory ; Ultrasonic investigative techniques ; Ultrasonography ; Ultrasound ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Journal of cerebral blood flow and metabolism, 2011-08, Vol.31 (8), p.1716-1724</ispartof><rights>2011 ISCBFM</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Aug 2011</rights><rights>Copyright © 2011 International Society for Cerebral Blood Flow & Metabolism, Inc. 2011 International Society for Cerebral Blood Flow & Metabolism, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-6f0eae34285916c061f414b335291a77e35707615f99a91990b13f37a8f192e93</citedby><cites>FETCH-LOGICAL-c510t-6f0eae34285916c061f414b335291a77e35707615f99a91990b13f37a8f192e93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170938/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170938/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,21798,27901,27902,43597,43598,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24432887$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21364598$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kern, Rolf</creatorcontrib><creatorcontrib>Diels, Anna</creatorcontrib><creatorcontrib>Pettenpohl, Johanna</creatorcontrib><creatorcontrib>Kablau, Micha</creatorcontrib><creatorcontrib>Brade, Joachim</creatorcontrib><creatorcontrib>Hennerici, Michael G</creatorcontrib><creatorcontrib>Meairs, Stephen</creatorcontrib><title>Real-Time Ultrasound Brain Perfusion Imaging with Analysis of Microbubble Replenishment in Acute MCA Stroke</title><title>Journal of cerebral blood flow and metabolism</title><addtitle>J Cereb Blood Flow Metab</addtitle><description>Real-time ultrasound perfusion imaging (rt-UPI) allows visualization of microbubbles flowing through the cerebral microvasculature. We hypothesized that analysis of microbubble tissue replenishment would enable for characterization of perfusion deficits in acute middle cerebral artery (MCA) territory stroke. Twenty-three patients (mean age 70.2 ± 13.2 years, 9 weeks) were included. Sequential images of bubble replenishment were acquired by transcranial rt-UPI at low mechanical index immediately after microbubble destruction. Different parameters were calculated from regions of interest (ROIs): real-time time to peak (rt-TTP), rise rate (β), and plateau (A) of acoustic intensity, and A×β was used as an index of blood flow. Results were compared with diffusion-weighted and perfusion magnetic resonance imaging. Parameters of rt-UPI had lower values in ROIs of ischemic as compared with normal tissue (β = 0.58 ± 0.40 versus 1.25 ± 0.83; P = 0.001; A = 1.44 ± 1.75 versus 2.63 ± 2.31; P = 0.05; A×β = 1.14 ± 2.25 versus 2.98 ± 2.70; P = 0.01). Real-time time to peak was delayed in ischemic tissue (11.43 ± 2.67 versus 8.88 ± 1.66 seconds; P < 0.001). From the analysis of receiver operating characteristic curves, β and A×β had the largest areas under the curve with optimal cutoff values of β < 0.76 and A×β < 1.91. We conclude that rt-UPI with analysis of microbubble replenishment correctly identifies ischemic brain tissue in acute MCA stroke.</description><subject>Acoustics</subject><subject>Age</subject><subject>Biological and medical sciences</subject><subject>Brain</subject><subject>Brain - blood supply</subject><subject>Brain Ischemia - physiopathology</subject><subject>Cerebral blood flow</subject><subject>Infarction, Middle Cerebral Artery - diagnostic imaging</subject><subject>Infarction, Middle Cerebral Artery - physiopathology</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Ischemia</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical sciences</subject><subject>Microbubbles</subject><subject>Microcirculation - physiology</subject><subject>Microvasculature</subject><subject>Nervous system</subject><subject>Neuroimaging</subject><subject>Neurology</subject><subject>Original</subject><subject>Perfusion</subject><subject>Perfusion Imaging - methods</subject><subject>ROC Curve</subject><subject>Stroke</subject><subject>Territory</subject><subject>Ultrasonic investigative techniques</subject><subject>Ultrasonography</subject><subject>Ultrasound</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0271-678X</issn><issn>1559-7016</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqN0c9rFDEUB_BBFLutHr1KEEQQZs2bTH5dCuvij0KLUlvwFjLTZDfbTLImM5X-9864a6viwVMO-eS9l_ctimeA54CJeLNpG9vNKwwwh_pBMQNKZckxsIfFDFccSsbF14PiMOcNxlgQSh8XBxUQVlMpZsX1udG-vHCdQZe-TzrHIVyht0m7gD6bZIfsYkAnnV65sELfXb9Gi6D9bXYZRYvOXJtiMzSNN-jcbL0JLq87E3o0vl-0Q2_Q2XKBvvQpXpsnxSOrfTZP9-dRcfn-3cXyY3n66cPJcnFathRwXzKLjTakrgSVwFrMwNZQN4TQSoLm3BDKMWdArZRagpS4AWIJ18KCrIwkR8Xxru52aDpz1Y7jJO3VNrlOp1sVtVN_3gS3Vqt4owhwLIkYC7zaF0jx22ByrzqXW-O9DiYOWQlBxtViqP5DYg6SYTbKF3_JTRzSuMoJTXGwmo-o3KFxqzknY--GBqymuNXPuNUUt4J69M9__-md_pXvCF7ugc6t9jbp0Lp87-qaVEJMjV_vXNYrcz_Zv7v-AGiwwGQ</recordid><startdate>20110801</startdate><enddate>20110801</enddate><creator>Kern, Rolf</creator><creator>Diels, Anna</creator><creator>Pettenpohl, Johanna</creator><creator>Kablau, Micha</creator><creator>Brade, Joachim</creator><creator>Hennerici, Michael G</creator><creator>Meairs, Stephen</creator><general>SAGE Publications</general><general>Nature Publishing Group</general><general>Sage Publications Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7QO</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>5PM</scope></search><sort><creationdate>20110801</creationdate><title>Real-Time Ultrasound Brain Perfusion Imaging with Analysis of Microbubble Replenishment in Acute MCA Stroke</title><author>Kern, Rolf ; Diels, Anna ; Pettenpohl, Johanna ; Kablau, Micha ; Brade, Joachim ; Hennerici, Michael G ; Meairs, Stephen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-6f0eae34285916c061f414b335291a77e35707615f99a91990b13f37a8f192e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Acoustics</topic><topic>Age</topic><topic>Biological and medical sciences</topic><topic>Brain</topic><topic>Brain - blood supply</topic><topic>Brain Ischemia - physiopathology</topic><topic>Cerebral blood flow</topic><topic>Infarction, Middle Cerebral Artery - diagnostic imaging</topic><topic>Infarction, Middle Cerebral Artery - physiopathology</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Ischemia</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical sciences</topic><topic>Microbubbles</topic><topic>Microcirculation - physiology</topic><topic>Microvasculature</topic><topic>Nervous system</topic><topic>Neuroimaging</topic><topic>Neurology</topic><topic>Original</topic><topic>Perfusion</topic><topic>Perfusion Imaging - methods</topic><topic>ROC Curve</topic><topic>Stroke</topic><topic>Territory</topic><topic>Ultrasonic investigative techniques</topic><topic>Ultrasonography</topic><topic>Ultrasound</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kern, Rolf</creatorcontrib><creatorcontrib>Diels, Anna</creatorcontrib><creatorcontrib>Pettenpohl, Johanna</creatorcontrib><creatorcontrib>Kablau, Micha</creatorcontrib><creatorcontrib>Brade, Joachim</creatorcontrib><creatorcontrib>Hennerici, Michael G</creatorcontrib><creatorcontrib>Meairs, Stephen</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Applied & Life Sciences</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of cerebral blood flow and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kern, Rolf</au><au>Diels, Anna</au><au>Pettenpohl, Johanna</au><au>Kablau, Micha</au><au>Brade, Joachim</au><au>Hennerici, Michael G</au><au>Meairs, Stephen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Real-Time Ultrasound Brain Perfusion Imaging with Analysis of Microbubble Replenishment in Acute MCA Stroke</atitle><jtitle>Journal of cerebral blood flow and metabolism</jtitle><addtitle>J Cereb Blood Flow Metab</addtitle><date>2011-08-01</date><risdate>2011</risdate><volume>31</volume><issue>8</issue><spage>1716</spage><epage>1724</epage><pages>1716-1724</pages><issn>0271-678X</issn><eissn>1559-7016</eissn><coden>JCBMDN</coden><abstract>Real-time ultrasound perfusion imaging (rt-UPI) allows visualization of microbubbles flowing through the cerebral microvasculature. We hypothesized that analysis of microbubble tissue replenishment would enable for characterization of perfusion deficits in acute middle cerebral artery (MCA) territory stroke. Twenty-three patients (mean age 70.2 ± 13.2 years, 9 weeks) were included. Sequential images of bubble replenishment were acquired by transcranial rt-UPI at low mechanical index immediately after microbubble destruction. Different parameters were calculated from regions of interest (ROIs): real-time time to peak (rt-TTP), rise rate (β), and plateau (A) of acoustic intensity, and A×β was used as an index of blood flow. Results were compared with diffusion-weighted and perfusion magnetic resonance imaging. Parameters of rt-UPI had lower values in ROIs of ischemic as compared with normal tissue (β = 0.58 ± 0.40 versus 1.25 ± 0.83; P = 0.001; A = 1.44 ± 1.75 versus 2.63 ± 2.31; P = 0.05; A×β = 1.14 ± 2.25 versus 2.98 ± 2.70; P = 0.01). Real-time time to peak was delayed in ischemic tissue (11.43 ± 2.67 versus 8.88 ± 1.66 seconds; P < 0.001). From the analysis of receiver operating characteristic curves, β and A×β had the largest areas under the curve with optimal cutoff values of β < 0.76 and A×β < 1.91. We conclude that rt-UPI with analysis of microbubble replenishment correctly identifies ischemic brain tissue in acute MCA stroke.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>21364598</pmid><doi>10.1038/jcbfm.2011.14</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acoustics Age Biological and medical sciences Brain Brain - blood supply Brain Ischemia - physiopathology Cerebral blood flow Infarction, Middle Cerebral Artery - diagnostic imaging Infarction, Middle Cerebral Artery - physiopathology Investigative techniques, diagnostic techniques (general aspects) Ischemia Magnetic Resonance Imaging Medical sciences Microbubbles Microcirculation - physiology Microvasculature Nervous system Neuroimaging Neurology Original Perfusion Perfusion Imaging - methods ROC Curve Stroke Territory Ultrasonic investigative techniques Ultrasonography Ultrasound Vascular diseases and vascular malformations of the nervous system |
| title | Real-Time Ultrasound Brain Perfusion Imaging with Analysis of Microbubble Replenishment in Acute MCA Stroke |
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