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Intraoperative Superb Microvascular Imaging (SMI) with contrast agent of ultrasonography
EANS Academy. Ishikawa M. Sep 27, 2019; 276122; EP12060
Abstract
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Objective: We reported the usefulness of intraoperative ultrasonography (US) with the Superb Microvascular Imaging (SMI) technique to detect low flow components. We combined this SMI technique with contrast agent technique and applied this US imaging for neurosurgery to distinguish tumor or hematoma from brain and to examine blood flow in moyamoya disease.
Methods: Twenty patients with brain tumor, 7 patients with ICH and 2 patients with moyamoya disease underwent operation under US monitoring using Aplio US system combining the SMI and contrast agent techniques. Features of the SMI include
(1) visualization of low-velocity flow with minimal motion artifact,
(2) high resolution of images, and
(3) high frame rates.
We calculated appearance time of contrast agent and vessel density in tumor and brain. In a hemorrhage onset type patient with moyamoya disease, US monitoring showed flow from lateral ventricle vessel to cerebral surface, and we analyzed lateral ventricle vessels of hemorrhage onset type patients (n=14) with original images of magnetic resonance angiography to compare to infarction onset type patients with moyamoya disease (n=22) and patients with unruptured aneurysm (n=20).
Results: Vessel flow was clearly visualized by the SMI and contrast agent techniques. Appearance time of contrast agent was decreased and vessel density was increased in tumor significantly, compared to brain. In hemorrhage onset type patients with moyamoya disease, arteries in lateral ventricles were increased significantly. In ICH patients, we could find hematoma as avascular area with the US monitoring.
Conclusion: Intraoperative US monitoring using the SMI and contrast agent techniques produced pioneering images to recognize cerebral and tumor vessels and recognize avascular area in hemorrhage patienets. Asymptomatic patients with moyamoya disease may be hemorrhage onset type, when the patients have some arteries in lateral ventricles judging from the original images of the magnetic resonance angiography.
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