Echo-Enhanced Transcranial Color Coded Duplexsonography versus Digital Subtraction Angiography for Diagnosis of Intracranial Vascular Diseases
Objective: To assess the diagnostic efficacy of echo-enhanced transcranial color coded duplexsonography (eTCCD) for noninvasive evaluation of the intracranial vasculature in patients with cerebrovascular symptoms. MATERIAL AND METHODS: We prospectively evaluated 35 consecutive patients (10 women, 25 men, mean age 58,8 ± 9,7) with eTCCD (galactose palmitic acid based echo-enhancing agent) and digital subtraction angiography (DSA). All patients were admitted to our neurology department for acute onset of cerebrovascular symptoms. RESULTS: In 34/35 patients eTCCD visualized the circle of Willis. In 15/17 patients with critical symptomatic internal carotid artery obstruction (lumen diameter reduction of >85% or occlusion) eTCCD correctly identified collateral flow patterns through the circle of Willis. DSA and eTCCD showed MCA-occlusion in 4 patients. In one of these patients eTCCD correctly identified a contralateral severe MCA-stenosis, which was first missed by DSA but confirmed by angiographic reevaluation. In 1 patient eTCCD missed occlusion of a M3-segment. In 2/3 patients eTCCD showed intracranial ICA-stenosis. In 3 patients with symptoms suggestive for basilar artery thrombosis DSA and eTCCD showed severe basilar stenosis in 1 patient and intracranial vertebral artery occlusion in 2 patients. DSA and eTCCD were normal in 3 patients with atypical intracranial hemorrhages and in 1 patient with subarachnoid hemorrhage. In another patient eTCCD correctly suggested a left parietooccipital AVM. DSA and eTCCD were normal in 4 other patients. CONCLUSION: eTCCD reliably detects occlusion, stenosis and collateral flow patterns of the basal cerebral arteries in patients with cerebral ischemia. For patients with cerebral hemorrhage our data are limited.