Evaluating Post-Interventional Occlusion Grades of Cerebral Aneurysms with Transcranial Contrast-Enhanced Ultrasound (CEUS) Using a Matrix Probe

Abstract

Purpose: The main goal of cerebral endovascular aneurysm therapy is the complete occlusion of the aneurysm. Along with the development of new aneurysm treatment devices, repeated controls are necessary. We examined whether contrast-enhanced ultrasound can help to monitor aneurysms after endovascular treatment.

Materials and Methods: We prospectively examined 12 patients after coiling (7 patients) or flow diverter (FD) implantation (5 patients). These patients were examined with transcranial contrast-enhanced ultrasound using a matrix probe (1 – 5 MHz). Doppler sonography, Power Doppler, contrast harmonic imaging (CHI) and Power Doppler sonography (CPD) were included in the examination. Digital subtraction angiography with 3 D reconstructions served as the gold standard. Two radiologists decided in consensus about the degree of aneurysm occlusion separately in CEUS and digital subtraction angiography using a 4-point grading scheme.

Results: The degree of occlusion of the 12 aneurysms comparing the two imaging modalities was identical in 10 cases. In two cases CHI and CPD showed a small aneurysm remnant after coiling in the center of the coil pack while in digital subtraction angiography the aneurysms seemed completely occluded.

Conclusion: The investigation indicates that contrast-enhanced ultrasound is a supportive, noninvasive method for post-interventional controls of intracranial aneurysms due to its ability to display not only macro- but also microvascularization.

Zusammenfassung

Ziel: Ziel der interventionellen Therapie zerebraler Aneurysmen ist ein kompletter Verschluss, wobei neue endovaskuläre Behandlungsmethoden wiederholte postinterventionelle Kontrollen erfordern. Wir untersuchten daher, ob eine Verlaufsbeurteilung von endovaskulär versorgten zerebralen Aneurysmen mittels Kontrast-verstärktem transkraniellem Ultraschall (CEUS) möglich ist.

Material und Methoden: Wir führten prospektiv bei 12 Patienten einen transkraniellen, Kontrast-verstärkten Ultraschall inklusive Doppler, Power Doppler, Contrast Harmonic Imaging und Kontrast-verstärktem Power Doppler nach Coiling (7 Patienten) oder Flow Diverter Implantation (5 Patienten) mit einer Matrixsonde (1 – 5 MHz) durch. Goldstandard war die digitale Subtraktionsangiographie (DSA) inklusive der 3D-Rekonstruktion. Zwei Radiologen bewerteten im Konsensusverfahren den Verschlussgrad der Aneurysmen in der DSA sowie dem Ultraschall anhand einer 4-Grad-Einteilung.

Ergebnisse: Eine Übereinstimmung von Ultraschall und Angiographie bestand in 10 Fällen. Bei zwei Aneurysmen konnte nach Coiling in CEUS ein geringer Restfluss im Aneurysma detektiert werden, wohingegen in der Angiographie die Aneurysmen als verschlossen bewertet wurden.

Schlussfolgerung: Die Ergebnisse deuten darauf hin, dass CEUS aufgrund seiner Fähigkeit zur Darstellung sowohl der Makro- als auch der Mikrovaskularisation ein hilfreiches, nicht-invasives Verfahren zur wiederholten Kontrolle endovaskulär versorgter intrakranieller Aneurysmen ist.

Key words

contrast-enhanced ultrasound - aneurysm - flow diverter - contrast harmonic imaging

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