Visualization of the cerebral circulation using three-dimensional transcranial power Doppler ultrasound imaging

The purpose of this study was to evaluate the anatomy of the cerebral circulation, particularly the circle of Willis, using three-dimensional ultrasound (3DUS) imaging. Image data were obtained through the right transtemporal window from 8 young, healthy volunteers by acquiring gray-scale and color Doppler spectral (CDI) and energy (CDE) images using two-dimensional ultrasound equipment with a 2-MHz probe. Images and transducer position coordinates were fed into a graphics workstation, reprojected, analyzed to extract the blood flow signal, volume rendered, and displayed interactively. The architecture of the cerebral circulation was evaluated from multiple orientations using stereo viewing glasses and rotation to enhance the understanding of vessel position. The primary vessels of the cerebral circulation including the circle of Willis and bilateral views of the branching arteries (middle, anterior, and posterior cerebral arteries and internal carotid artery) could be imaged readily with 3DUS through one transtemporal window. Acquisition time was typically less than 30 seconds. Volume-rendering methods greatly assisted in showing the overall spatial relationships and continuity of cranial vessels. Secondary branches of the cerebral arteries were seen in 2 patients. Color data from two-dimensional ultrasound imaging that otherwise might be identified as artifact was found to represent continuous small vessels on three-dimensional viewing. 3DUS facilitates imaging of cranial vascular anatomy by clarifying overall spatial relationships and enhancing comprehension, compared to two-dimensional ultrasound methods. The method is rapid and the circle of Willis can be visualized from one side of the head.