Bedside US and Contrasted Enhanced US Findings in Symptomatic Neonatal Stroke: A Case Series Study Correlated With MRI

The purpose of this study was to evaluate bedside cranial ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) for demonstrating changes in neonatal arterial ischemic stroke (NAIS). Fifteen newborns with symptomatic NAIS underwent a cranial ultrasound examination and subsequently confirmed by magnetic resonance imaging (MRI), were enrolled. Color Doppler Flow Imaging (CDFI) and Pulsed-Wave Doppler (PW) were performed to acquire data from 6 coronal, 5 sagittal, and 3 cerebellar planes through the anterior or mastoid fontanelle. For CEUS, a 2-minute wash-in cine clip and static images were captured. CUS showed all lesions in the blood-supplying region of the middle cerebral artery (MCA), with 10(66.7%) located on the left hemisphere, and on the right. CEUS was performed on 3 neonates to evaluate microvascular perfusion. Two cases showed a large area of non-enhancement on the lesion side, while the third case showed significantly higher enhancement on the lesion side. MRI confirmed all lesions in the MCA blood-supplying region, with 10 on the left hemisphere and 5 on the right. Magnetic resonance angiography (MRA) identified abnormalities in the trunk or branches of the MCA in 8 neonates. Our preliminary results suggest that CUS can evaluate NAIS in conjunction with MRI and CEUS metrics may have potential for clinical quantification, warranting future validation studies.