Abstract
Over the past 20 years, ultrasonic cerebral perfusion imaging (UPI) has been introduced and validated applying different data acquisition and processing approaches. Clinical data were collected mainly in acute stroke patients. Some efforts were undertaken in order to compare different technical settings and validate results to gold standard perfusion imaging. This review illustrates the evolution of the method, explicating different technical aspects and milestones achieved over time. Up to date, advancements of ultrasound technology as well as data processing approaches enable semi-quantitative, gold standard proven identification of critically hypo-perfused tissue in acute stroke patients. The rapid distribution of CT perfusion over the past 10 years has limited the clinical need for UPI. However, the unexcelled advantage of mobile application raises reasonable expectations for future applications. Since the identification of intracerebral hematoma and large vessel occlusion can also be revealed by ultrasound exams, UPI is a supplementary multi-modal imaging technique with the potential of pre-hospital application. Some further applications are outlined to highlight the future potential of this underrated bedside method of microcirculatory perfusion assessment.
Highlights
Cerebral Ultrasound Perfusion Imaging (UPI), First Clinical ApplicationsUltrasound imaging is a key diagnostic tool in clinical medicine
There are a few studies on patients with intracranial hemorrhage (ICH) where ultrasonic cerebral perfusion imaging (UPI) was used either to improve sonographic detectability of ICH or to describe perihemorrhagic penumbral perfusion
Cerebral ultrasound perfusion imaging has the potential to serve as a supplementary tool to conventional diagnostics in various clinical questionings
Summary
Ultrasound imaging is a key diagnostic tool in clinical medicine. Even if an expert examiner is needed to obtain and interpret the images, it is advantageous to other diagnostic entities for various reasons, two of them being the mobile bedside character of the examination and the absence of radiation exposure. Besides gray-scale B-mode imaging for tissue characterization, vessel imaging by Doppler-based duplex-sonography is the basis in most diagnostic work-up settings. Ischemic stroke and its diagnostic work up is the leading indication for ultrasound imaging questioning the vessel status of extra- and intracranial arteries. With the invention of contrast-enhanced perfusion imaging, the question of transferability to cerebral imaging quickly emerged. SScchheemmaattiicc rreepprreesseennttaattiioonn ooff iinnssoonnaattioionnpplalanneeininttrraannsstetemmppooraral luultlrtarsaosuoundndimimagaignigng(a()a,), aaddaapptteedd ffrroomm [[1133]] ((wwiitthh ppeerrmmiissssiioonn ooff ccooppyyrriigghhtt oowwnneerr)) wwiitthh aa ccoorrrreessppoonnddiningg““bbilialateteraral”l”BB-m-mooddee imimaaggee((bb)) wwiitthh eexxppllaannaattoorryyaannaatotommicicaal llalnanddmmarakrsk:sw: hwitheitaerraorwrosw=sfr=onfrtoalnhtaolrnhsoronf ssiodfesvidenetvriecnletsr;ic*l=es; *m=idmliindeli,nteh,irtdhirvdenvterinctlrei;crlee;dreadrroarwros w= sco=nctroanlatrtaelraatlesrkaul sllk. CC(TCC)TTinffodollillcooawwte--suuptph..e((TTth)) iiirnndddviicceaantteterssictthlheee, atthhdiiarrdpdtvevdeennfttrrroiicmcllee,[,1aa5dd]aawppttietehddpffrreoormmmi[s[11s55io]]n frwwomiitthhEpplseeerrvmmieiissrs.siioonn ffrroomm EEllsseevviieerr.. (vFtoNcstbihaoeifFtovN(cswmFtovN(cswogleib)ibarnoaofievmfpiemteoiugoielo)grl)tnrpnteatvpavprte-utherefuhoetooguettireaaatear-rrc-ofarefofheotgbtritgtrtietleh-conh3acaeofhaeeefheilseplnlien-.b3en-csaee3eaieessipnsepnhfn.clbvs.cbUehpseapnaeaeneehfhylfUvelUvaesuakauareaeaapeeyayrmesrecskabrprkawbrpremirma’trcacrwtlernwlsfieiaietiiortiertsontanasfitasfieloeepeotleosieosihnlthltdalreal(letsleetnnenldeoodlreldsarltsanrn(d(sdoar(troarrktasampto(o(ras’irusa’sksekptestptasuirautiirrenyeetctienthatiratirp“cyscphcynhtgnitntk“intc(“stubacfeieiirkieuk(Tufa(bagirfbagrurdirrTaoTaadrlcudPrmieaumieeasaaclePncrlePtvrsasIsreatvr.etstvasiaIe.)ieI.eete.eestds)aer)(eTaredeaTdi(snaTr(sTen,ienniTr,TrPi,abni,PntaPaaotbPsaostbPrlPIsyras,Irl,uIunla”yniayIui”Iui”Ipcspcspcr.rho.hr1hpluro1uloarr1lapeapreceree6ooec6rerc6rroroecaearca(a(urcrau(aulrtluwrowtllowtfllmumtonfmtnuoftuoununhuuhuhshhdhsdsdeesd2nye2nsyi2syiiiieiitoteito0ett0dioet0doeeodevvoeedvendndnerrnernsnoososaaadbd)oi)bioib)lloblrmrrimmyiuuiufaymfryamfrryabmbnonnoonntawtanatyybhbahwatbthwawtgddggdeeehgglleeglweeweeaaeseaessiiititt)rcMM)cntr)nrcoMnhhhoohh,,e,kkk(gf(ggf(aeifeaeiaa11at1altananlealilne)c)cd)dcidinnissnsdndnownnodoweweleeeeleireairereagppgpagppn)inripr)ric)t)ctmciimemtieidieeehuhincuncahcuaas)ns)sutettetetnpehenpnhitpieeiehdneadoneaondooododoaoolusntlusnttnmtnsnmltngtomgheoheohtrdorgdooldroloofyoofyyacfiatoloitffginkpgfaotonkpontpnngkthfhenefgeolehgfodrdoeergclnecrned-oae-ponpo-ootpt(epp(etnmptonmbaolebalnm(eooeoelaltbtetoltalraruitaruiFiaatiFardaliFauefdteftilscalidscfuieeuelnldginsdgluklkcarganrdysflysltuatluaklnasyenaueetaelo2nd2rledrledddrdrar2e.wdec.ddcirf5irf5er.scelseolinop5np1ro1;toestrhnrph1worwao:rao:awetrwehi:aiortwtesabpdbsabpb))uiut;ts;,pbtaf,rbfuaaruuae)rettrtaaafaaarar,upertereeterrtdldadaeldaierare,ierrtt,ooldmaaaaeedmaaidar,sasaorrrpdmadprppyaynagsnegtetrrtthtmethypnmedtrfdgtereteeerrhrorermeoetdddtrddiypoiypeerprreorpcec.nmdtnipy.nftnfpeofrofcoroirN.irsNirnstnitmootmofmsomsooei[Nersiohmotmohmo1mnmsmanoeatftf2hoooogptmengpteai[]i[snftsne[oaae[a1tapg1etit1iw1isrssldnhr2l[dh2eaaol2oetl2eti1t]yese]yiseerldhsf]tf]t.2ot.lethyees]ft
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