The field of neurovascular ultrasound is expanding rapidly with exciting new applications. While ultrasound contrast agents were initially used to overcome insufficient transcranial bone windows for identification of the basal cerebral arteries, new-generation microbubbles in combination with very sensitive contrast-specific ultrasound techniques now enable real-time visualization of stroke. This article will provide a review of recent and emerging developments in ultrasound technology and contrast-specific imaging techniques for evaluation of acute stroke patients.

Seidel G, Algermissen C, Christoph A, Claassen L, Vidal-Langwasser M, Katzer T: Harmonic imaging of the human brain. Visualization of brain perfusion with ultrasound. Stroke 2000;31:151–154.
Seidel G, Greis C, Sonne J, Kaps M: Harmonic grey scale imaging of the human brain. J Neuroimaging 1999;9:171–174.
Postert T, Muhs A, Meves S, Federlein J, Przuntek H, Buttner T: Transient response harmonic imaging: an ultrasound technique related to brain perfusion. Stroke 1998;29:1901–1907.
Meairs S, Daffertshofer M, Neff W, Eschenfelder C, Hennerici M: Pulse-inversion contrast harmonic imaging: ultrasonographic assessment of cerebral perfusion. Lancet 2000;355:550–551.
Federlein J, Postert T, Meves S, Weber S, Przuntek H, Buttner T: Ultrasonic evaluation of pathological brain perfusion in acute stroke using second harmonic imaging. J Neurol Neurosurg Psychiatry 2000;69:616–622.
Harrer JU, Mayfrank L, Mull M, Klotzsch C: Second harmonic imaging: a new ultrasound technique to assess human brain tumour perfusion. J Neurol Neurosurg Psychiatry 2003;74:333–338.
Della Martina A, Meyer-Wiethe K, Allemann E, Seidel G: Ultrasound contrast agents for brain perfusion imaging and ischemic stroke therapy. J Neuroimaging 2005;15:217–232.
Postert T, Hoppe P, Federlein J, Helbeck S, Ermert H, Przuntek H, Buttner T, Wilkening W: Contrast agent specific imaging modes for the ultrasonic assessment of parenchymal cerebral echo contrast enhancement. J Cereb Blood Flow Metab 2000;20:1709–1716.
Schneider M, Arditi M, Barrau MB, Brochot J, Broillet A, Ventrone R, Yan F: BR1: a new ultrasonographic contrast agent based on sulfur hexafluoride-filled microbubbles. Invest Radiol 1995;30:451–457.
Kaps M, Seidel G, Bokor D, Modrau B, Algermissen C: Safety and ultrasound-enhancing potentials of a new sulfur hexafluoride-containing agent in the cerebral circulation. J Neuroimaging 1999;9:150–154.
Burns PN: Harmonic imaging with ultrasound contrast agents. Clin Radiol 1996;51(Suppl 1):50–55.
Kern R, Perren F, Kreisel S, Szabo K, Hennerici M, Meairs S: Multi-planar transcranial ultrasound imaging – Standards, landmarks and correlation with magnetic resonance imaging. Ultrasound Med Biol 2005;31:311–315
Rim SJ, Leong-Poi H, Lindner JR, Couture D, Ellegala D, Mason H, Durieux M, Kassel NF, Kaul S: Quantification of cerebral perfusion with ‘Real-Time’ contrast-enhanced ultrasound. Circulation 2001;104:2582–2587.
Meairs S, Seidel G: Transcranial ultrasound. EFSUMB guidelines and good clinical practice recommendations in contrast-enhanced ultrasound – Update. In press.
Wiesmann M, Meyer K, Albers T, Seidel G: Parametric perfusion imaging with contrast-enhanced ultrasound in acute ischemic stroke. Stroke 2004;35:508–513.
Seidel G, Meyer-Wiethe K, Berdien G, Hollstein D, Toth D, Aach T: Ultrasound perfusion imaging in acute middle cerebral artery infarction predicts outcome. Stroke 2004;35:1107–1111.
Eyding J, Krogias C, Schollhammer M, Eyding D, Wilkening W, Meves S, Schroder A, Przuntek H, Postert T: Contrast-enhanced ultrasonic parametric perfusion imaging detects dysfunctional tissue at risk in acute MCA stroke. J Cereb Blood Flow Metab 2006;26:576–582.
Eyding J, Nolte-Martin A, Krogias C, Postert T: Changes of contrast-specific ultrasonic cerebral perfusion patterns in the course of stroke; reliability of region-wise and parametric imaging analysis. Ultrasound Med Biol 2007;33:329–334.
Holscher T, Wilkening W, Draganski B, Meves SH, Eyding J, Voit H, Bogdahn U, Przuntek H, Postert T: Transcranial ultrasound brain perfusion assessment with a contrast agent-specific imaging mode: results of a two-center trial. Stroke 2005;36:2283–2285.
Sobesky J, Zaro WO, Lehnhardt FG, Hesselmann V, Thiel A, Dohmen C, Jacobs A, Neveling M, Heiss WD: Which time-to-peak threshold best identifies penumbral flow? A comparison of perfusion-weighted magnetic resonance imaging and positron emission tomography in acute ischemic stroke. Stroke 2004;35:2843–2847.
Kern R, Perren F, Schoeneberger K, Gass A, Hennerici M, Meairs S: Ultrasound microbubble destruction imaging in acute middle cerebral artery stroke. Stroke 2004;35:1665–1670.
Meyer-Wiethe K, Cangur H, Seidel GU: Comparison of different mathematical models to analyze diminution kinetics of ultrasound contrast enhancement in a flow phantom. Ultrasound Med Biol 2005;31:93–98.
Diels A, Pettenpohl J, Kern R, Kablau M, Sick C, Hennerici M, Meairs S: Real-time microbubble refill kinetics in patients with MCA infarction. Cerebrovasc Dis 2007;23(suppl 1):1–76.
Eyding J, Krogias C, Wilkening W, Postert T: Detection of cerebral perfusion abnormalities in acute stroke using phase inversion harmonic imaging (PIHI): preliminary results. J Neurol Neurosurg Psychiatry 2004;75:926–929.
Pettenpohl J, Diels A, Kablau M, Kern R, Sick C, Hennerici M, Meairs S: Dynamic microvascular perfusion maps for assessment of brain infarction. Cerebrovasc Dis 2007:23(suppl 1):1–76.
Kaps M, Seidel G, Gerriets T, Traupe H: Transcranial duplex monitoring discloses hemorrhagic complication following rt-PA thrombolysis. Acta Neurol Scand 1996;93:61–63.
Seidel G, Cangur H, Albers T, Meyer-Wiethe K: Transcranial sonographic monitoring of hemorrhagic transformation in patients with acute middle cerebral artery infarction. J Neuroimaging 2005;15:326–330.
Kern R, Kablau M, Sallustio F, Stroick M, Hennerici M, Meairs S: Improved detection of intracerebral hemorrhage with transcranial ultrasound perfusion imaging. Cerebrovasc Dis, in press.
Molina CA, Ribo M, Rubiera M, Montaner J, Santamarina E, Delgado-Mederos R, Arenillas JF, Huertas R, Purroy F, Delgado P, Alvarez-Sabin J: Microbubble administration accelerates clot lysis during continuous 2-MHz ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator. Stroke 2006;37:425–429.
Perren F, Loulidi J, Poglia D, Landis T, Sztajzel R: Microbubble potentiated transcranial duplex ultrasound enhances IV thrombolysis in acute stroke. J Thromb Thrombolysis 2007, E-pub ahead of print.
Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, Montaner J, Saqqur M, Demchuk AM, Moye LA, Hill MD, Wojner AW: Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med 2004;351:2170–2178.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.