Brain PERfusion Evaluation by Contrast-Enhanced UltraSound

Study Overview
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Brief Summary
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The objective of the study is to assess brain tissue perfusion by contrast-enhanced ultrasound perfusion imaging (PerCEUS) in acute brain injuries. More precisely, it aims : to evaluate the heterogeneity of brain perfusion and thus diagnose brain tissue hypoperfusion with contrast-enhanced ultrasound. to correlate contrast-enhanced ultrasound with perfusion measurements by usual multimodal monitoring.

Detailed Description
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The main aim is to evaluate the heterogeneity of brain perfusion, thus diagnosing brain tissue hypoperfusion with PerCEUS, then to correlate it with the usual multimodal monitoring. Earlier after hospitalization in neurointensive care, when the study physician needs to realize a contrast ultrasound imaging and without delaying any emergency procedure, a PerCEUS will be performed in patients with an acute brain injury. After acquisition, data from PerCEUS will be transferred to an external evaluation unit and analysed offline, using commercially available software Qlab (Philips ®). According to the localization of acute brain injuries with magnetic resonance imaging (MRI) and/or computed tomography (CT), several regions-of-interest (ROI, at least three in each area) will be chosen : Area 1 : in the core of the lesion (supposed non perfused) Area 2 : just next to the lesion (supposed hypoperfused) Area 3 : in the saner hemisphere, symmetrically to area 2 each time it's possible (supposed well-perfused). Every parameters of multimodal monitoring used at the moment of PerCEUS will be relieved : intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP) mean flow velocity (MFV) by transcranial doppler (TCD) regional cerebral oxygen saturation (rSO2) by Near infrared spectroscopy (NIRS) jugular venous oximetry (SjvO2). The actual PerCEUS measurement takes place at the bedside, is performed by the study physician, and takes about 5 minutes. The trial duration per patient is 30 minutes, ending after 25 minutes of oversight

Official Title
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Quantification of Cerebral Perfusion at the Patient's Bedside When Performing Contrast-enhanced Ultrasound in Neurointensive Care Patients

Conditions
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Cerebral Hemorrhage, Subarachnoid Hemorrhage, Ischemic Stroke, Cerebrovascular Circulation, Perfusion

Intervention / Treatment
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* Diagnostic Test: Measuring contrast-enhanced ultrasound perfusion with phase inversion harmonic imaging


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥18 Intensive care unit admission for acute brain injury Proven acute brain injury by CT and/or MRI Requiring a contrast ultrasound imaging Informed consent of patient or relative Exclusion Criteria: Pregnancy Not sufficient temporal window Contraindications to Sonovue ® : acute coronary syndromes, severe ischemic heart disease (requiring revascularization), pulmonary arterial hypertension > 90 mmHg, right-left shunt, ARDS, dobutamine's use, known allergy or adverse reaction to Sonovue® Patient on State Medical Assistance

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with acute brain injuries when a contrast ultrasound imaging is requested by the physician<br>Contrast-enhanced ultrasound perfusion imaging (PerCEUS) | Diagnostic Test: Measuring contrast-enhanced ultrasound perfusion with phase inversion harmonic imaging<br>* Contrast-enhanced ultrasound perfusion imaging (PerCEUS) will be performed by a dedicated study team. The transcranial color duplex sonography will be performed with a 1-5 MHz dynamic sector array (S5-1) from a Philips Epiq 7 ultrasound machine (Philips Healthcare, Andover, MA). The field-of-view will be set to an imaging depth of 150 mm in a sector angle of 90°. The imaging plane will be then tilted to the diencephalic, in which the frontal horns of the side ventricles and the third ventricle serve as landmarks and where the anterior and posterior middle cerebral artery (MCA) territory and the basal ganglia (BG) as region of interest could be identified without artefacts from major vessels. High mechanical index bolus imaging will be performed from the sanest side of the head. Data acquisition of 45 seconds will be recorded immediately after the beginning of the contrast ultrasound imaging, using a mechanical index (MI) setting of 1.1 and a frame rate of 33 Hz.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of the heterogeneity of brain perfusion by time-to-peak (TPI) measurement | Comparison between time-to-peak (TPI) intensities measured in ROIs in each area by PerCEUS | 30 minutes after PerCEUS | 
| Evaluation of the heterogeneity of brain perfusion by peak-intensities (PI) measurement | Comparison between peak-intensities (PI) measured in ROIs in each area by PerCEUS | 30 minutes after PerCEUS | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between PerCEUS parameters and cerebral perfusion as assessed by ICP and MAP | Correlations test between TPI/PI and ICP/CPP/MAP | 30 minutes after PerCEUS | 
| Correlation between PerCEUS parameters and cerebral perfusion as assessed by TCD | Correlations test between TPI/PI and MFV | 30 minutes after PerCEUS | 
| Correlation between PerCEUS parameters and cerebral perfusion as assessed by NIRS | orrelations test between TPI/PI and rSO2 | 30 minutes after PerCEUS | 
| Correlation between PerCEUS parameters and cerebral perfusion as assessed by SjvO2 | Correlations test between TPI/PI and SjvO2 | 30 minutes after PerCEUS | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Contrast-enhanced ultrasonography, Ultrasound contrast agent, Intra-cranial pressure, Intracerebral hematoma, Neurocritical care, Brain perfusion, Cerebral blood flow, Diagnostic imaging, Ultrasonography Doppler, Doppler ultrasound, Transcranial Doppler, Contrast enhanced ultrasound, Contrast ultrasound, Ultrasound perfusion imaging