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Fusion imaging in neurosonology: Clinician’s questions, technical potentials and applicability

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Ultrasound is a well established imaging technique with widespread use in diagnosis and treatment monitoring of neurological diseases. However, direct and exact comparison of results from conventional ultrasound with other frequently used diagnostic modalities like magnetic resonance imaging (MRI) or computed tomography (CT) is impaired by different field of views and non-identical imaging planes. A new technical approach — ultrasoud fusion imaging might help to overcome this problem.


Fusion imaging is a technique which allows direct comparison of live ultrasound images with exactly corresponding images derived from pre-registered CT or MRI datasets. Different approaches for the matching procedure — manual or automated — can be applied for image fusion and movements of the patient are automatically corrected for.


The technique can widely be applied within the field of neurosonology. Clinical examples are given for its use in extra- and intracranial analysis of brain supplying arteries, intracranial parenchymal lesions but also for its use in peripheral nerve and muscle disease.


Ultrasound fusion imaging is a promising technique which permits easy and exact matching between live ultrasound and CT or MRI image modalities, allowing for the first time a direct comparison between these techniques. This is a major step forward towards the facilitation of information exchange, reduction of interobserver variability and improvenment of image documentation.

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  1. Valdueza JM, Schreiber SJ, Roehl J, Klingebiel R. Neurosonology and neuroimaging of stroke. 1st ed. Thieme international; 2008.

    Google Scholar 

  2. Walter U. Transcranial sonography in brain disorders with trace metal accumulation. Int Rev Neurobiol. 2010; 90:166–78.

    Article  Google Scholar 

  3. Stoll G, Wilder-Smith E, Bendszus M. Imaging of the peripheral nervous system. Handb Clin Neurol. 2013; 115:137–53.

    Article  Google Scholar 

  4. Kumar A, Chuan A. Ultrasound guided vascular access: efficacy and safety. Best Pract Res Clin Anaesthesiol. 2009; 23(3):299–311.

    Article  Google Scholar 

  5. Walter U, Dressler D. Ultrasound-guided botulinum toxin injections in neurology: technique, indications and future perspectives. Expert Rev Neurother. 2014; 14(8):923–36.

    Article  Google Scholar 

  6. Peterson MA, Abele J. Bedside ultrasound for difficult lumbar puncture. J Emerg Med. 2005; 28(2):197–200.

    Article  Google Scholar 

  7. Sandulescu DL, Dumitrescu D, Rogoveanu I, Saftoiu A. Hybrid ultrasound imaging techniques (fusion imaging). World J Gastroenterol. 2011; 17(1):49–52.

    Article  Google Scholar 

  8. De Beni S, Macciò M, Bertora F. Multimodality Navigation Tool ‘Navigator’. Conf Proc IEEE SICE Int Symp Meas Anal Model Hum Funct. 2004; 1–4.

    Google Scholar 

  9. Wood BJ, Zhang H, Durrani A, Glossop N, Ranjan S, Lindisch D, Levy E, Banovac F, Borgert J, Krueger S, Kruecker J, Viswanathan A, Cleary K. Navigation with electromagnetic tracking for interventional radiology procedures: a feasibility study. J Vasc Interv Radiol. 2005; 16(4):493–505.

    Article  Google Scholar 

  10. Wood BJ, Locklin JK, Viswanathan A, Kruecker J, Haemmerich D, Cebral J, Sofer A, Cheng R, McCreedy E, Cleary K, McAuliffe MJ, Glossop N, Yanof J. Technologies for guidance of radiofrequency ablation in the multimodality interventional suite of the future. J Vasc Interv Radiol. 2007; 18(1 Pt 1):9–24.

    Article  Google Scholar 

  11. Minami Y, Chung H, Kudo M, Kitai S, Takahashi S, Inoue T, Ueshima K, Shiozaki H. Radiofrequency ablation of hepatocellular carcinoma: value of virtual CT sonography with magnetic navigation. Am J Roentgenol. 2008; 190(6):W335–41.

    Article  Google Scholar 

  12. Crocetti L, Lencioni R, De Beni S, See TC, Pina CD, Bartolozzi C. Targeting liver lesions for radiofrequency ablation: an experimental feasibility study using a CT-US fusion imaging system. Invest Radiol. 2008; 43(1):33–9.

    Article  Google Scholar 

  13. Wood BJ, Kruecker J, Abi-Jaoudeh N, Locklin JK, Levy E, Xu S, Solbiati L, Kapoor A, Amalou H, Venkatesan AM. Navigation systems for ablation. J Vasc Interv Radiol. 2010; doi: 10.1016/j.jvir.2010.05.003.

    Google Scholar 

  14. Zhu L, Ding H, Zhu L, Wang G. A robust registration method for real-time ultrasound image fusion with pre-acquired 3D dataset. Conf Proc IEEE Eng Med Biol Soc. 2011; doi: 10.1109/IEMBS.2011.6090727.

    Google Scholar 

  15. Krücker J, Xu S, Venkatesan A, Locklin JK, Amalou H, Glossop N, Wood BJ. Clinical utility of real-time fusion guidance for biopsy and ablation. J Vasc Interv Radiol. 2011; 22(4):515–24.

    Article  Google Scholar 

  16. Di Mauro E, Solbiati M, De Beni S. Forzoni L, D’Onofrio S, Solbiati L. Virtual Navigator real- time ultrasound fusion imaging with positron emission tomography for liver interventions. Conf Proc IEEE Eng Med Biol Soc. 2013; doi: 10.1109/EMBC.2013.6609773.

    Google Scholar 

  17. Appelbaum L, Solbiati L, Sosna J, Nissenbaum Y, Greenbaum N, Goldberg SN. Evaluation of an electromagnetic image-fusion navigation system for biopsy of small lesions: assessment of accuracy in an in vivo swine model. Acad Radiol. 2013; 20(2):209–17.

    Article  Google Scholar 

  18. Milot L, Ma K, Efford E, Sela G, Coburn N, Haider M, Piron C, Plewes D, Law C. Evaluation of a multimodality MR/US coregistration system for investigation of hepatic metastases from colorectal cancer. J Vasc Interv Radiol. 2013; 24(3):357–62.

    Article  Google Scholar 

  19. Mauri G, Cova L, De Beni S, Ierace T, Tondolo T, Cerri A, Goldberg SN, Solbiati L. Real-time US-CT/MRI image fusion for guidance of thermal ablation of liver tumors undetectable with US: results in 295 cases. Cardiovasc Interv Radiol. 2014, doi: 10.1007/s00270-014-0897-y.

    Google Scholar 

  20. Forzoni L, D’Onofrio S, De Beni S, Laganà MM, Kolev V, Baselli G, Ciuti G, Righi D. Virtual Navigator tridimensional panoramic imaging in transcranial application. Biomed Tech. 2012; doi: 10.1515/bmt-2012-4282.

    Google Scholar 

  21. Forzoni L, D’Onofrio S, De Beni S, Laganà MM, Skoloudik D, Baselli G, Cecconi P. Virtual Navigator registration procedure for transcranial application. Biomed Eng. 2012; doi: 10.2316/P.2012.764-158.

    Google Scholar 

  22. Laganà MM, Preti MG, Forzoni L, D’Onofrio S, De Beni S, Barberio A, Cecconi P, Baselli G. Transcranial ultrasound and magnetic resonance image fusion with Virtual Navigator. IEEE T Multimedia. 2013; 15(5):1039–48.

    Article  Google Scholar 

  23. Schreiber SJ, Valdueza JM, Doepp F. Transcranial color coded sonography: advanced approach using ultrasound fusion imaging. Int J Clin Neurosci Ment Health. 2014; 1(Suppl. 1):S16.

  24. Walter U, Školoudík D. Transcranial sonography (TCS) of brain parenchyma in movement disorders: quality standards, diagnostic applications and novel technologies. Ultraschall Med. 2014; 35(4):322–31.

    Article  Google Scholar 

  25. Walter U, Niendorf T, Graessl A, Rieger J, Krüger PC, Langner S, Guthoff RF, Stachs O. Ultrahigh field magnetic resonance and colour Doppler real-time fusion imaging of the orbit—a hybrid tool for assessment of choroidal melanoma. Eur Radiol. 2014; 24(5):1112–7.

    Article  Google Scholar 

  26. Skoloudik D, Kuliha M, Roubec M, Havelka J, Langova K, Herzig R. Comparison of brain vessel imaging from transtemporal and transcondylar approaches using contrast-enhanced transcranial color-coded duplex sonography and Virtual Navigator. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014; doi: 10.5507/bp.2014.064.

    Google Scholar 

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Correspondence to Georgios Sakas.

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Schreiber, S.J., Sakas, G., Kolev, V. et al. Fusion imaging in neurosonology: Clinician’s questions, technical potentials and applicability. Biomed. Eng. Lett. 4, 347–354 (2014).

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