From the Departments of Neurology (M.G., R.K., M.B., S.J., C.-W.W.) and
Radiology (R.G.), University of Magdeburg, Magdeburg, Germany, and Schering
AG, Berlin, Germany (S.W.).
Correspondence to Michael Goertler, MD, Department of Neurology, University of Magdeburg, Leipziger Strasse 44, D-39120 Magdeburg, Germany. E-mail michael.goertler{at}medizin.uni-magdeburg.de
Background and Purpose—We sought to
evaluate the diagnostic value of echo-enhanced
transcranial color-coded duplex sonography (TCCD) and the
clinical relevance of vascular pathology assessed by sonography for
early clinical outcome in acute ischemic stroke.
Methods—We present 23 consecutive patients with an anterior
circulation stroke in whom clinical examination, CT, and
ultrasonography were performed within 5 hours after the onset of
symptoms. Transcranial Doppler sonography (TCD) and
unenhanced and contrast-enhanced TCCD (Levovist, 4 g, 300 mg/mL)
were compared for their ability to detect middle cerebral artery (MCA)
occlusion and flow velocity reduction suggesting
hemodynamic impairment in the MCA distribution pathway.
Sonographic examination times were registered. Baseline clinical
characteristics and CT findings were assessed. Neurological deficit was
quantified according to the National Institutes of Health Stroke Scale
score, with an early clinical improvement defined as decrease of the
score by 4 or more points or a complete resolution of the deficit on
day 4.
Results—Contrast-enhanced TCCD enabled diagnosis of intracranial
vascular pathology in 20 affected hemispheres, whereas unenhanced TCCD
and TCD were conclusive in 7 and 14 hemispheres, respectively
(P=0.0001). Contrast-enhanced TCCD was superior in
evaluating distal carotid (carotid-T) occlusion and differentiating
major vessel occlusions from patent arteries with flow velocity
diminution. Mean examination time for enhanced TCCD ranged from 5 to 7
minutes, depending on the number of investigated vessels (without or
with MCA branches). Logistic regression selected a patent MCA without
reduced blood flow velocity as the only independent predictor for an
early clinical improvement (P<0.01).
Conclusions—Contrast-enhanced TCCD is a promising tool for early
prognosis in anterior circulation stroke. It is considered superior to
unenhanced TCCD and TCD.
© 1998 American Heart Association, Inc.
Original Contributions
Diagnostic Impact and Prognostic Relevance of Early Contrast-Enhanced Transcranial Color-Coded Duplex Sonography in Acute Stroke
Key Words: cerebral ischemia • contrast media • diagnostic imaging • stroke outcome • ultrasonography, Doppler, duplex
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