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Transcranial perfusion sonography using a low mechanical index and pulse inversion harmonic imaging: reliability,
J U Harrer1, J Valaikiene, H Koch
1Neurology, MVZ at Caritas Klinik St. Theresia, Saarbrücken, Germany. judith.harrer@web.de
Ultraschall in Der Medizin (Stuttgart, Germany : 1980)
|April 24, 2010
Summary
Low mechanical index transcranial perfusion sonography (TPS) enables near real-time brain imaging. Experienced sonographers achieve high reliability, making TPS a valuable tool for assessing perfusion changes in conditions like stroke.
Area of Science:
- Neuroimaging
- Medical Ultrasound
- Cerebrovascular Physiology
Background:
- Transcranial perfusion sonography (TPS) is an emerging noninvasive technique for brain perfusion assessment.
- Evaluating TPS feasibility with low mechanical index (MI) and high frame rates is crucial for its clinical adoption.
Purpose of the Study:
- To assess the feasibility of a low MI/almost real-time frame rate approach for TPS.
- To determine the intra- and interobserver variability of TPS parameters.
Main Methods:
- 10 healthy volunteers underwent TPS three times using a low MI (1.0) and high frame rate (8.3 Hz).
- Two sonographers performed measurements in a crossover design to assess intra- and interobserver variability.
- Time-intensity curve (TIC) parameters including peak intensity (PI), time-to-PI (TTP), area-under-curve (AUC), and cerebral transit time (CTT) were calculated from 8 regions of interest (ROI).
Main Results:
- The overall quality of TICs was very good, with a mean r² of 0.92.
- Time-to-PI (TTP) and cerebral transit time (CTT) were the most robust parameters.
- Intraobserver variability was lower with more experienced sonographers (r=0.70 vs. r=0.29), and interobserver reliability was r=0.34 (p < 0.05).
Conclusions:
- Low MI TPS facilitates near real-time imaging and improved probe handling.
- Sonographer experience is key to achieving high reliability with TPS.
- TPS shows promise as a tool for diagnosing and monitoring perfusion changes, particularly in stroke and anti-angiogenic therapy.
