J. Powers 1, R. Seip 2, W. Shi 2
1 Philips Ultrasound, Bothell – WA, USA, 
2 Philips Research, Briarcliff – NY, USA

For many years existing ultrasound devices have been used for sonothrombolysis (STL) research in-vitro, in animals, and even in humans. These have included laboratory transducers, physiotherapy devices, and diagnostic ultrasound systems.

S. Yoshikazu, R. Suzuki, Y. Oda, D. Omata, K. Maruyama
Laboratory of Drug and Gene Delivery Faculty of Pharma-sciences – Tokyo, Japan

Objective: The combination thrombolysis therapy with recombinant tissue plasminogen activator (rt-PA), microbubbles and ultrasound, was reported higher recanalization ratio in ischemic cerebrovascular disease. Ultrasound and microbubbles vibrate the fibrin net and accelerate thrombolysis. Recently, we developed novel liposomal submicron bubbles (Bubble Liposome (BLs)) containing ultrasound imaging gas, perfluoropropane. In this study, we developed BLs with Arg-Gly-Asp (RGD) sequence-containing peptides, which bind to the activated platelet glycoprotein IIb/IIIa complexes. The aim of this study was to examine the enhancing effects in ultrasonic thrombus imaging using these targeted BLs in vitro and in vivo.

F. Abd-Allah
Neurosonology Unit, Cairo University – Cairo, Egypt

Objective: A noninvasive method of visualization of the spinal cord vasculature such as ultrasound that can be utilized in different clinical setting of spinal cord ischemia. We assessed the feasibility of imaging and characterizing blood flow in the anterior spinal artery using Ultrasound with concurrent validation using a cadaveric model.

Material and Methods: We developed a protocol for ultrasonographic assessment of anterior spinal artery based on anatomic, morphologic, and physiologic characteristics of anterior spinal artery and determined the feasibility in 24 healthy research participants using high frequency probe (3-9 MHz) through the left lateral paramedian approach in the area between T8 and T12. We ascertained the detection rate, depth of insonation, and flow parameters, including peak systolic velocity, end diastolic velocity, and resistivity indexes for both segmental arteries and anterior spinal artery within the field of insonation. We validated the anatomical landmarks using simultaneous spinal angiography and simulated anterior spinal artery flow in a cadaveric set-up.

T. Tegos, A. Petrakis, A. Valavanis, A. Safouris, A. Papadimitriou, A. Orologas
A Neurology Department, AHEPA Hospital, Aristotelian University of Thessaloniki – Thessaloniki, Greece

Objective: Previous studies concluded that symptomatic carotid plaques are echolucent on ultrasound, whereas asymptomatic ones are echogenic. The aim of this study was to determine whether juxtaluminal plaque echogenicity (juxtaluminal 25% plaque area) constitutes a better discriminator of the symptomatic and asymptomatic status, as compared to global plaque echogenicity, in various degrees of stenosis.

Material and Methods: Analysis involved imaging by duplex of 100 carotid plaques of more than 50% stenosis (86 patients, 50 symptomatic and 50 asymptomatic plaques), capturing, digitisation and normalisation in a computer in a standard way. The global plaque Grey Scale Median (GSMglobal) was evaluated to distinguish dark (low GSM) from bright (high GSM) plaques. Subsequently, juxtaluminal 25% plaque area GSM (GSMjl25%) was evaluated semi-quantitatively in the same computer software. Stenosis was evaluated on duplex.

M. De Lima Oliveira, H. Picarelli, A. Blassioli Barbosa, S. Brasil Lima, M. Jacobsen Teixeira, E. Bor-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: Radical resection of brain metastases can be associated with better outcome. The gold standard intraoperatory method to detect residual tumors is magnetic resonance (RM). However this method requires long image acquisitions time, intravenous contrast (gadolinium) to disclose residual lesions and is restrict to some neurosurgical centers. Among the image methods, intra operatory ultrasound (IOUS) has been a reliable tool for assessing residual lesions after macroscopic tumor excision.

Material and Methods: Thirty six patients with presumed diagnosis of brain metastases (BM) were underwent a surgery with IOUS to pint point tumors, delineate their margins and intra operatory control resection. A total 46 lesions were removed by microscopic surgeries. IOUS was performed in all operations. A prospective study compared the last 2D IOUS control after tumor resection with pos operatory magnetic resonance (MRI) and enhanced contrast tomography (CT) in terms of quality in residual lesion detection. Control MRI and enhanced CT were performed in 75% of patients. Control CT and MRI were considered when it was performed until five months after surgery.

M. Siebler
Mediclin /Essen Kettwig, Department of Neurorehabilitation/ University of Duesseldorf – Essen, Germany

Objective: By means of ultrasound (US) methods structural and functional properties of the muscle tissue could be detected in patients in real time and non-invasively. Using tissue velocity imaging (TVI) we are able to investigate the dynamics of movements in identified muscles. We tested whether this method could be applicated to measure the forearm muscle motions in order to monitor rehabilitation therapies and pharmacological effects.

Material and Methods: The voluntary movement of hand opening (M.ext. digitorum) and closing (M.flexor digitorum) was analyzed in healthy subjects (n=30) and stroke patients (n= 31) using the B-mode and tissue velocity imaging (TVI). TVI is based on the Doppler effect to record slow movements of the tissue and was adapted on a 6-8 MHz probe. We recorded synergistic contractions or dephasing (non-synchronous muscle activity) and quantified velocity of contraction and relaxation as well as there repetition frequency.

M. Tanter
Institut Langevin, ESPCI, INSERM, CNRS – Paris, France

In the last fifteen years, the concept of plane wave transmissions rather than line by line scanning beams broke the conventional limits of ultrasound imaging. By using such large field of view transmissions, the frame rate reaches the theoretical limit of physics dictated by the ultrasound speed and an ultrasonic map can be provided typically in tens of micro-seconds (>1000 frames per second). Interestingly, this leap in frame rate is not only a technological breakthrough offering completely new ultrasound imaging modes and open new application, but at such frame rates, it becomes possible to track in real time transient vibrations – known as shear waves – propagating through organs and provides quantitative maps of tissue stiffness whose added value for diagnosis has been recently demonstrated in many fields of radiology.

C. Vetta 1, S. Horner 1, H. Deutschmann 2, T. Gattringer 1, K. Niederkorn 1
1 Department of Neurology,
2 Department of Radiology, Medical University – Graz, Austria

Objective: Stenoses of intracranial arteries (IAS)are responsible for 10% - 15% of all ischemic strokes.The purpose of the present study was to retrospectively identify the outcome of endovascular treatments of IAS with Stent-PTA performed at the University Hospital Graz during the period of 2003 to 2012.

Material and Methods: Data from all patients who underwent interventional procedures during the period 2003–2012, caused by a symptomatic (transient ischemic attack or stroke) stenosis of a major intracranial artery, were extracted from a stent data base. Technical success, clinical outcome, the rate of instent restenosis (ISR) and recurrent stroke as well as prognosis were defined as primary objectives. Examinations were at 24 hours and 6 months after the procedure, as well as the last consultation of the stroke outpatient clinic.

E. B. Ringelshtein
University Hospital Münster, Department of Neurology – Münster, Germany

Microembolic signals (MES) detected by transcranial ultrasound have first been described in the 80ies by Merrill Spencer and have rapidly gained great importance for the exploration of the pathophysiology underlying various stroke etiologies. Finally, MES have been proven as a reliable biomarker concerning the prognosis of symptomatic and asymptomatic internal carotid artery (ICA) stenoses. Typical clinical indications for microembolus detection (MD), a time-consuming, investigator-dependent US technique, are monitoring of cardiac and carotid surgery, arterial interventions, detection of occult sources of embolism, defining the culprit in competing sources of embolism, development of less emboligenic surgical techniques and refined devices.