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(Stroke. 1997;28:2473-2478.)
© 1997 American Heart Association, Inc.
Articles |
Contrast-Enhanced Transcranial Color-Coded Duplex Sonography in Ischemic Cerebrovascular Disease
From the Department of Neurology, University Hospital, Bern, Switzerland.
Correspondence to Ralf W. Baumgartner, MD, Neurologische Klinik, Frauenklinikstrase 26, CH-8091 Zürich, Switzerland. E-mail Strusbmg{at}neurol.unizh.ch
Background and Purpose Echo contrast agents have been shown to provide conclusive examinations in most patients with insufficient ultrasound penetration through the temporal bone. We investigated the diagnostic value of contrast-enhanced (CE) transcranial color-coded duplex sonography (TCCD) in patients with ischemic cerebrovascular disease and insufficient temporal windows and evaluated TCCD criteria that predict whether CE-TCCD studies may become conclusive.
Methods Thirty-three patients presenting with
ischemic strokes (n=21) and transient ischemic attacks
(n=12) were investigated. Extracranial color duplex imaging showed
normal findings in 24 patients, eight 
70% stenoses and one
occlusion of the carotid arteries in 8 patients, and severe occlusive
disease of both vertebral arteries in 1 patient. Seven carotid
stenoses and vertebral artery obstructions were confirmed by
angiography. The galactose/palmitic acid–based echo contrast agent was
injected intravenously as bolus of 200, 300, or 400 mg/mL
in a dosage of 10, 5, and 5 mL, respectively.
Results Thirty-two of the 33 patients were completely examined because 1 patient who felt pain at the injection site declined further investigations. Twenty-one (66%) of 32 CE studies were conclusive and showed cross-flow through three anterior and two posterior communicating arteries, but no stenoses and occlusions. Precontrast identification of any cerebral artery provided an overall accuracy of 97% in predicting a conclusive CE investigation. Precontrast TCCD identified no arterial Doppler signals in patients with inconclusive CE studies.
Conclusions CE-TCCD provided conclusive examinations in two thirds of patients with ischemic cerebrovascular disease and ultrasound-refractory temporal windows. Precontrast detection of any cerebral artery reliably predicted a conclusive CE investigation.
Key Words: cerebral arteries • contrast media • ultrasonics
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