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Second Harmonic Imaging of the Human Brain: The Practicability of Coronal Insonation Planes and Alternative Perfusion Parameters

Background and Purpose— Second harmonic imaging (SHI) is a novel ultrasound technique that allows the evaluation of brain tissue perfusion. The purpose of this study was to assess normal cerebral echo contrast characteristics in 3 regions of interest (ROIs) in the transverse axial and coronal insonation planes through the temporal bone window. Materials and Methods— SHI examinations were performed in 25 patients without cerebrovascular disease (aged 50±19 years) in a transverse axial and a coronal diencephalic insonation plane through the temporal bone window. After intravenous administration of 2.5 g (400 mg/mL) of a galactose-based echo contrast agent, 62 time-triggered images with a transmission rate of 1 frame per 2.5 seconds were recorded for offline analysis. Time-intensity curves, including peak intensity (PI) (dB) and positive gradient (PG) (dB/s), were calculated to quantify ultrasound intensity in 3 different ROIs in both planes of the following sections: the thalamus (ROIthal), the lentiform nucleus (ROIncl), and the area supplied by the middle cerebral artery (ROImca). Results— Characteristic time-intensity curves with high PIs and steep PGs were recorded in each ROI. Statistical analysis of the aforementioned parameters showed no significant difference for comparison of the 3 ROIs in the transverse axial versus the coronal insonation plane. Comparison of different ROIs in the transverse axial insonation plane revealed that PI was significantly higher in ROIthal than in ROImca (7.8 versus 5.5 dB;P <0.05) and significantly higher in ROIncl than in ROIthal (9.3 versus 7.8 dB;P <0.05). In contrast, PG was comparable in ROIthal and in ROImca (0.21 versus 0.25 dB/s;P =0.42). Conclusions— SHI is a promising technique for the evaluation of cerebral parenchymal perfusion. Comparison of the transverse axial and coronal insonation planes shows similar time-intensity curves with comparable values for PIs and PGs. Coronal insonation allows the evaluation of perfusion abnormalities near the vertex and skull base, areas that cannot be depicted in the transverse axial plane. Comparison of the different ROIs indicates that the PG is a more robust and reliable parameter than the PI.