Zusammenfassung
Ziel: Die Ultraschallperfusionsbildgebung des ischämischen Schlaganfalls konzentriert sich
auf große Infarkte im Stromgebiet der Arteria cerebri media. Diese Studie untersuchte,
ob auch kleine Infarkte potenziell darstellbar sind. Material und Methoden: Bei Patienten mit bekannten, kleinen (< 3 cm Durchmesser), den Thalamus involvierenden
Infarkten wurden Perfusionsmessungen mit Phasen-Inversions-Technik (PIHI) von beiden
Seiten in axialer, diencephaler Schnittführung durchgeführt. Die Infarktlokalisation
und Perfusionsstörung waren von der MRT bekannt. Der Signalanstieg durch den Echokontrastmittelbolus
(Bolus Kinetik, SonoVue®) wurde mit PIHI anhand der Parameter Peak-Signal-Increase
(PSI) und Time-to-Peak (TTP) quantifiziert. Ergebnisse: Siebzehn Patienten (51 ± 11 Jahre; 24 % weiblich) mit 18 Infarkten (16 unilateral,
einer bilateral) von weniger als 3 cm maximalem Durchmesser wurden untersucht. Sechs
Untersuchungen (18 %) waren aufgrund des Knochenfensters für eine Analyse unzureichend.
In der Analyse konnten neun von zehn Infarkten mit einem Durchmesser > 2 cm identifiziert
werden (Sensitivität 90 %). Infarkte mit einem Durchmesser < 2 cm entgingen dem Nachweis
fast vollständig. Schlussfolgerung: PIHI hat das Potenzial, auch kleine, den Thalamus involvierende Infarkte zu identifizieren.
Die Detektion ist abhängig von der Infarktgröße und hoch sensitiv für Infarkte, deren
maximaler Durchmesser mehr als 2 cm beträgt.
Abstract
Purpose: Ultrasound (US) perfusion imaging of ischemic stroke has mainly been applied to large
middle cerebral artery infarction. We investigated whether small stroke involving
the thalamus can also be detected. Materials and Methods: Phase inversion harmonic imaging (PIHI) was applied to patients with small infarctions
involving the thalamus (maximal longitudinal infarct diameter less than 3 cm). PIHI
was performed from both the left and right side in axial diencephalic planes. Infarct
size and location as well as perfusion properties (MTT maps) were known from MRI.
US perfusion parameters were derived from the signal enhancement time course (bolus
kinetics, SonoVue®) for peak-signal increase and time-to-peak. Results: Seventeen patients (52 ± 11 years, 24 % female) with 18 strokes (16 unilateral, 1
bilateral) were included. Six US examinations (18 %) were inadequate for analysis
due to an insufficient transtemporal bone window. US perfusion depicted 90 % of infarcts
with a longitudinal diameter of more than 2 cm. Infarcts with a longitudinal diameter
of less than 2 cm were hardly identified. Conclusion: PIHI allows identification of a small infarction involving the thalamus subject to
infarct size.
Key words
phase inversion harmonic imaging - imaging of brain - stroke - thalamus
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Dr. Christian H. Nolte
Neurology, Charite Campus Benjamin Franklin
Hindenburgdamm 30
12200 Berlin
Telefon: ++ 49/30/84 45 22 75
Fax: ++ 49/30/84 45 42 64
eMail: christian.nolte@charite.de