Value of ultrasound fusion imaging in detecting vascular cerebral white matter pathology

Cornelia Brunner; Stephan Joachim Schreiber; Martin Bokemeyer; Gerhard Ransmayr; Walter Struhal; Elisabeth Daniela Olbert; Naela Alhani; Milan Rastislav Vosko

doi:10.1186/s13089-022-00275-5

Value of ultrasound fusion imaging in detecting vascular cerebral white matter pathology

Ultrasound J. 2022 Jun 17;14(1):25. doi: 10.1186/s13089-022-00275-5.

Authors

Cornelia Brunner^{1

2

3}, Stephan Joachim Schreiber^{3

4}, Martin Bokemeyer³, Gerhard Ransmayr², Walter Struhal¹, Elisabeth Daniela Olbert¹, Naela Alhani¹, Milan Rastislav Vosko⁵

Affiliations

¹ Department of Neurology, Karl Landsteiner University of Health Sciences, University Hospital Tulln, Alter Ziegelweg 10, 3430, Tulln, Austria.
² Department of Neurology, Kepler University Hospital, 2, Krankenhausstraße 09, 4020, Linz, Austria.
³ Department of Neurology, Asklepios Clinic Brandenburg, Anton-Saefkow-Allee 2, 14772, Brandenburg an der Havel, Germany.
⁴ Department of Neurology, Oberhavel Kliniken, Clinic Hennigsdorf, Marwitzer Straße 91, 16761, Hennigsdorf, Germany.
⁵ Department of Neurology, Kepler University Hospital, 2, Krankenhausstraße 09, 4020, Linz, Austria. milan.vosko@kepleruniklinikum.at.

Abstract

Background: Transcranial sonography is beside magnetic resonance imaging (MRI) and computed tomography, a well-established imaging method for evaluation of brain parenchyma and already implicated in various neurological disorders as bed-side investigation possibility in clinical routine. The aim of this study was the qualitative assessment detecting vascular white matter hyperintensities (WMHs), with ultrasound fusion-imaging technique (UFI) and to find the optimal location for their visualization in accordance to the grade of WMHs and to possibly providing a standardized protocol for clinical use.

Results: 29 patients with WMHs of variable degree quantified according to Fazekas grading scale (n = 13 I; n = 9 II; n = 7 III) and 11 subjects with normal findings on MRI were identified for further analysis. Ultrasound images were analyzed to a standardized protocol and predefined anatomical landmarks. UFI could visualize the MRI-verified WMHs in 147 of 161 localizations (91%). The overall ultrasound detection rate of WMHs increased with higher degree of WMHs burden (I:85%, II:94%, III:97%). The highest sensitivity was achieved at the contralateral central part (CPc) (97%) of the lateral ventricle. The inter-rater analysis between 2 independent raters, who were blinded to the patient's diagnosis and assessed only the B-mode ultrasound images, indicated an 86% agreement with an overall moderate strength of agreement (κ: 0.489, p < 0.0005) for all localizations. The highest accordance within raters was shown at the CPc; 92% (κ: 0.645, p < 0.0005).

Conclusions: This explorative study describes prospectively the ultrasound detection of periventricular vascular WMHs based on MRI lesions using UFI. Transcranial ultrasound (TCS) could serve as an additional screening opportunity for the detection of incidental WMLs during routine TCS investigations to initiate early vascular risk factor modification in primary prevention.

Keywords: Magnetic resonance imaging; Transcranial sonography; Ultrasound fusion-imaging; White matter hyperintensities.

Grants and funding

18/2017/Austrian Society of Neurology