Quantitative, noninvasive assessment of intra‐ and extraocular perfusion by contrast‐enhanced ultrasonography and its clinical applicability in healthy dogs

OBJECTIVE: To assess quantitative perfusion of intra‐ and extraocular regions of interest (ROIs) in conscious, healthy dogs utilizing contrast‐enhanced ultrasonography (CEUS); to compare varying enhancement with the first and second bolus injection and in the right and left eye; and to determine the most appropriate examination time. PROCEDURES: Gray scale ultrasonography and contrast harmonic imaging using sulfur hexafluoride were performed randomly assigned in both eyes in 10 university‐owned beagles. Perfusion parameters including slope time, time to peak (TTP), peak intensity (PI), and area under the curve (AUC) were measured at individually drawn ROIs (retrobulbar cone = ROI 1, choroid‐retina complex = ROI 2, medial = ROI 3, and lateral anterior uvea = ROI 4). RESULTS: Time‐intensity curve parameters revealed no significant differences in eyes examined by the first or second bolus injection (P > 0.05) or in the right or left eye (P > 0.05). Pooled data from all eyes were analyzed. Peak intensity of ROI 2 was significantly higher compared to all other ROIs (P < 0.001). Area under the curve at ROI 2 was significantly higher compared to all other ROIs (P < 0.05), and AUC at ROI 1 was significantly higher than at ROI 4 (P < 0.05). No significant differences in TTP were observed between different ROIs (P > 0.05). Ratios relative to different ROI sizes showed fastest enhancement in the retrobulbar cone and most intense perfusion in the anterior uveal regions. The first minute after contrast injection provided the highest diagnostic value. CONCLUSION: Quantitative perfusion in nondiseased canine eyes revealed consistent parameters. Application of standardized CEUS protocols may be a promising diagnostic tool to differentiate ocular lesions.