Stroke, Vol 24, 1903-1909, Copyright © 1993 by American Heart Association
F Ries, C Honisch, M Lambertz and R Schlief
BACKGROUND AND PURPOSE: Transtemporal insonation in transcranial Doppler
sonography is often impaired by an insufficient signal-to-noise ratio,
especially in elderly patients. A transpulmonary stable air microbubble
suspension was injected intravenously in humans as an intracranial
ultrasonic contrast agent. METHODS: In a clinical phase II study, 20
patients (15 women, 5 men; mean age, 65.5 +/- 11.5 years) presenting with
clinical indications for transcranial Doppler investigation were examined.
A total of 97 intravenous injections with different concentrations (200,
300, and 400 mg/mL of suspension) of air microbubbles bound to galactose
microparticles as a carrier were performed. The signal enhancement of
color-coded pulse curves of basal cerebral arteries was evaluated off-line
in comparison to an integrated color-coded decibel scale, considering
quality, quantity, and time course of enhancement requiring a 3-dB level
above the native signal. The overall diagnostic information was assessed
according to a reliability score. RESULTS: The first acoustic signal
increase was registered after an average of 21 seconds. Time intervals for
a dose- dependent peak intensity and maximal duration were 41.3 +/- 17.1
seconds and 118.0 +/- 69.8 seconds (200 mg/mL); 55.5 +/- 27.7 seconds and
237.0 +/- 112.3 seconds (300 mg/mL); and 66.1 +/- 31.8 seconds and 293.0
+/- 122.0 seconds (400 mg/mL), respectively. Duration of signal enhancement
increased significantly (P < .05) with higher concentrations. The extent
of signal enhancement during the whole pulse curve reached an average of
9.1 +/- 5.0 dB for 200 mg/mL, 12.0 +/- 5.4 dB for 300 mg/mL (significant on
P < .05 level), and 13.1 +/- 5.6 dB for 400 mg/mL concentration (P =
NS). Respective maximal intensity spots reached 17.5 +/- 6.0, 20.7 +/- 5.5,
and 22.7 +/- 5.9 dB for increasing concentrations, respectively. Overall
visual assessment of enhanced pulse curves for diagnostic reliability
showed a sufficient result in 38.1% of all injections with 200 mg/mL, in
88.6% with 300 mg/mL, and in 84.2% with 400 mg/mL concentration. Minimal
side effects occurring in 12.4% of all injections were all reversible.
CONCLUSIONS: Transpulmonary stable air microbubbles bound to a galactose
carrier represent a useful and safe contrast agent in case of an
insufficient native signal in transcranial Doppler investigation.
ARTICLES
A transpulmonary contrast medium enhances the transcranial Doppler signal in humans
Department of Neurology, University Clinic Bonn, FRG.
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