Diagnostic and Prognostic Value of Contrast-Enhanced Ultrasound in Acute Stroke

Abstract

In the last decade transcranial color-coded sonography (TCCS) was established as a routine in neurovascular departments for the evaluation of brain-supplying vessels in cerebrovascular diseases. TCCS has demonstrated feasibility and validity for the evaluation of the basal cerebral arteries, especially for the middle cerebral artery (MCA). In some patients an insufficient bone window may limit the diagnostic power. The application of microbubble agents can overcome this limitation in most patients. Beside the demonstration of vessel pathology such as stenosis and occlusion, TCCS also provides prognostic information. In the case of proximal MCA occlusion shown by TCCS within 6 hours of stroke, nearly 90 % of the patients suffered an unfavorable outcome. Furthermore TCCS is suitable for monitoring thrombolysis in acute stroke to detect whether there is recanalization of the affected vessel. The possibility for bedside examination, the non-invasiveness and the cost-effectiveness are features which make TCCS an optimal tool for the evaluation of cerebral vessels in acute ischemic stroke.

In vivo Biodistribution of Radiolabeled Acoustic Protein Nanostructures

“…Contrast-enhanced ultrasound (CEUS), with lipid- or protein-stabilized gas microbubbles, plays an important role in patient care and is evolving as a fundamental screening tool in cardiology, oncology and gynecology [1]. CEUS is used in a variety of clinical applications such as detecting and characterizing focal liver lesions [2], evaluating cerebral circulation for stroke [3], brain death diagnosis [4], kidney [5], liver and pancreas cancer prognosis, and contrast echocardiography [6–9]. The majority of these clinical applications are based on perfusion imaging and utilize conventional untargeted microbubbles.…”

Advanced Ultrasound Techniques for Neuroimaging in Pediatric Critical Care: A Review

“…Although attenuation by bone can partially limit visualization of intracranial structures, the use of contrast allows visualization of intracranial microvessels as compared to transcranial Doppler, which is limited to macrovascular imaging [ 23 , 24 ]. This has several theoretical uses, including evaluation of stroke [ 25 , 26 , 27 , 28 , 29 ], more subtle perfusion changes in the setting of arterial stenosis [ 30 ], and brain death [ 24 ]. Other windows, such as transcondylar, suboccipital, and transforaminal through the foramen magnum may increase the probability of intracranial macro- and microvascular flow assessment in cases where the transtemporal approach is insufficient.…”

Recent advances in molecular, multimodal and theranostic ultrasound imaging

“…In neurology and intensive care medicine, contrast-enhanced transcranial Doppler ultrasound has been established as a reliable tool to evaluate the cerebral circulation, e.g. to outline vessel stenosis and occlusion as well as ultimately, to diagnose brain death [13, 14]. Besides liver, cardiac and brain imaging, indications for CEUS have expanded to applications in the kidney [15, 16], in vesico-ureteric reflux [17, 18], in the pancreas [18-21], in trauma patients [22] and in cerebral circulation, as well as in oncological studies [23, 24].…”