Intraoperative ultrasound using phase inversion harmonic imaging: First experiences

Thilo Hölscher, Burak Ozgur, Soren Singel, Wilko G. Wilkening, Robert F. Mattrey, Hoi Sang

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


OBJECTIVE: To study the feasibility of intraoperative ultrasound using the phase inversion harmonic imaging (PIHI) technique. METHODS: Eight patients with intracranial middle cerebral artery aneurysms and five patients with arteriovenous malformations were studied after written informed consent. A first ultrasound study was performed through the intact dura mater after cranial trepanation to assess the pathology, its feeding artery, and downstream segments. A second ultrasound study was performed immediately after intervention to monitor the success of the procedure. All patients were studied using a Siemens Sonoline Antares ultrasound machine (Siemens Medical Solutions USA, Inc., Malvern, PA) before and after intravenous administration of an ultrasound contrast agent (Optison; GE Healthcare, Milwaukee, WI). Other than conventional brightness mode, PIHI is sensitive to the nonlinear acoustic response of tissue, and especially to ultrasound contrast agent microbubbles. The latter enables contrast-specific vascular imaging. RESULTS: PIHI provided anatomically detailed information. In combination with an ultrasound contrast agent, angiography-like views of the vascular pathologies, including their surrounding vessels, could be obtained. Flow velocities in afferent and downstream vascular segments, as well as inside the pathology, could be assessed. Flow dynamics inside the aneurysm sac or the arteriovenous malformation could be studied in real-time. Postintervention, contrast-enhanced PIHI could be used to immediately monitor the success of the surgical procedure. CONCLUSION: PIHI enables intraoperative visualization and morphological assessment of neurovascular pathologies, such as middle cerebral artery aneurysms or arteriovenous malformations. In combination with an ultrasound contrast agent, the flow dynamics of these lesions can be displayed in real-time.

Original languageEnglish (US)
Pages (from-to)ONS-382-ONS-386
Issue number4 SUPPL. 2
StatePublished - Apr 2007


  • Aneurysm
  • Arteriovenous malformation
  • Contrast agent
  • Flow dynamics
  • Harmonic imaging
  • Phase inversion
  • Ultrasound

ASJC Scopus subject areas

  • Medicine(all)


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