Volumetric acoustic angiography and perfusion imaging for bedside monitoring of cerebral hemodynamics after aneurysmal subarachnoid hemorrhage

Position du problème et objectif(s) de l’étude

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition frequently complicated by delayed cerebral ischemia (DCI). Early detection of cerebral perfusion deficits is critical yet remains limited by current imaging modalities, which are not suited for repeated bedside monitoring. The primary objective of this study was to assess the feasibility and safety of a novel 3D contrast-enhanced ultrasound (CEUS) platform for bedside volumetric cerebral angiography and perfusion imaging in aSAH patients. Secondary objectives included the evaluation of perfusion patterns over time and their correlation with clinical outcomes.

Matériel et méthodes

The study followed the ethical standards set by the World Medical Association’s Declaration of Helsinki for research involving human participants and received the authorization of CPP Sud-Méditerranée II (Ref: 2023-A01978-37). A prospective feasibility study was conducted in 13 patients with confirmed aSAH, of whom 11 completed three CEUS sessions at admission, day 5, and day 10. Using a matrix array probe, bilateral 3D CEUS acquisitions were performed through the temporal bone window following a bolus injection of Sonovue® contrast agent. Two reconstruction modes were generated: Microvascular Imaging (MVI) for angiographic visualization, and perfusion mapping based on Time-Intensity Evolution (TIE) curves. Key perfusion parameters included Time-to-Peak (TTP), Mean Transit Time (MTT), and hemispheric symmetry.

Résultats & Discussion

A total of 66 acquisitions were performed, with 95% yielding successful contrast enhancement. MVI imaging consistently visualized the main cerebral arteries, including the ICA, ACA, MCA, and PCA (Fig.1). Perfusion analysis (Fig.2) revealed differences between patients with favorable and unfavorable clinical evolutions. Stable, symmetric perfusion maps were observed in patients with good outcomes, while delayed and heterogeneous perfusion was associated with clinical deterioration. On day 5, TIE profiles showed a strong correlation with outcomes at discharge, with 88.9% concordance between perfusion classification and neurological prognosis. While this supports the potential prognostic value of CEUS-derived perfusion data, these findings remain exploratory within the context of a feasibility study.

Conclusion

This study demonstrates that bedside 3D CEUS is a feasible and safe imaging method for assessing cerebral perfusion in aSAH patients. It enables non-invasive, real-time monitoring of vascular morphology and flow dynamics directly in the neurocritical care unit. The additional insights gained from secondary analyses suggest promising clinical utility for prognostic assessment, which warrants further validation in larger, controlled studies.

Auteurs

Clément GAKUBA (1) , Louise DENIS (2), Chabouh GEORGES CHABOUH (2), Maxime GAUBERTI (3), Jean-Denis MOYER (1), Nathalie LAQUAY (1), Tom GAVET (1), Sylvain BODARD (2), Arthur CHAVIGNON (4), Vincent HINGOT (4), Denis VIVIEN (3), Olivier COUTURE (2) - (1)Chu Caen Normandie, Caen, France, (2)Sorbonne Université, Cnrs, Inserm, Laboratoire D’imagerie Biomédicale, Paris., Paris, France, (3)Unicaen, Inserm Umrs 1237, Caen., Caen, France, (4)Resolve Stroke, 75006, Paris., Paris, France

Orateur(s)

Clément GAKUBA (Caen)