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.
Age ≥18
Intensive care unit admission for acute brain injury
Proven acute brain injury by CT and/or MRI
Requiring a contrast ultrasound imaging
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
Patients hospitalized in neurosurgical intensive care in Lariboisière Hospital, Paris, with acute brain injuries
Cohort
Prospective
Measuring contrast-enhanced ultrasound perfusion with phase inversion harmonic imaging
Diagnostic testContrast-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.
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
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
Correlation between PerCEUS parameters and cerebral perfusion as assessed by ICP and MAP
Correlations test between TPI/PI and ICP/CPP/MAP
Correlation between PerCEUS parameters and cerebral perfusion as assessed by TCD
Correlations test between TPI/PI and MFV
Correlation between PerCEUS parameters and cerebral perfusion as assessed by NIRS
orrelations test between TPI/PI and rSO2
Correlation between PerCEUS parameters and cerebral perfusion as assessed by SjvO2
Correlations test between TPI/PI and SjvO2
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