Sonographic characteristics of small cerebral blood vessels: An in vitro and postmortem study

The ultrasound appearance of small cerebral blood vessels was investigated with in vivo and postmortem sonography. Linear echoes corresponding in distribution to small branches of major cerebral blood vessels, particularly deep medullary veins, were seen during cranial sonography of living neonates, neonatal postmortem brains, and adult postmortem brains following intravascular injection of a barium sulfate-gelatin suspension. Ease of visualization of the echoes was angle dependent, a phenomenon termed anisotropy. When imaged in cross-section, these reflectors appeared as tiny, closely spaced dots, demonstrating their tubular nature. Additionally, the barium-injected adult postmortem specimens were studied by computed tomography and plain-film radiography, enabling correlation between radiography and sonography. This study demonstrates that small branches of the major intracranial blood vessels can be imaged as linear echoes and closely spaced dots by high-resolution sonography. It is important to recognize the vascular origin of these echoes to avoid the pitfall of misinterpreting them as originating from pathologic processes such as periventricular leukomalacia.