We investigated the diagnostic potential of transcranial color-coded real-time sonography in 52 individuals using a phased-array ultrasound system with color-coded blood flow representation. Ultrasound scans in the axial and coronal planes were feasible through temporal acoustic bone windows in 49 subjects, enabling depiction of the main parenchymal and vascular structures as well as the ventricular system. Color-coded representation of blood flow in the cerebral vessels allowed unequivocal identification of the circle of Willis within the anatomic black-and-white B-mode image of the parenchymal structures. In Doppler mode, vascular blood flow phenomena may be analyzed semiquantitatively using the Doppler frequency spectrum. This noninvasive, serially applicable, mobile bedside method may complement conventional neuroradiologic imaging methods, allowing on-line studies of functional processes within the adult brain. {Stroke 1990;21:1680-1688) S ince Pape et al 1 reported two-dimensional sonographic illustration of cerebral damage in preterm infants in 1979, B-mode ultrasound scanning of the infant brain has become a standard pediatric examination method. The adult brain with its intact skull remained inaccessible to sophisticated ultrasound investigation until the pioneering work in 1982 of Aaslid et al, 2 who described pulsed-wave transcranial Dopplersonography. Recently, Schoning et al 34 indicated that B-mode sonography of the central nervous system (CNS) is feasible through the intact temporal plate of the adolescent and adult cranium. As a further development, we introduce transcranial color-coded real-time sonography of the adult brain and describe the application techniques, ultrasound anatomy, and feasibility in an adult population. Subjects and MethodsWe examined 52 individuals (13 normal healthy controls and 39 neurologic patients without CNS involvement; 17 women, mean age 51.7 years and 35 men, mean age 46.9 years). Duration of the bedside examinations varied from <5 minutes for the initial screening to 30 minutes for a complete sonographic evaluation.We used a phased-array ultrasound system with color-coded blood flow representation (Sonoline CF, From the Department of Neurology, Julius-Maximilians University Wurzburg, Wurzburg, F.R.G.Address for correspondence: Ulrich Bogdahn, MD, Department of Neurology, Intensive Care Unit, Josef-Schneider StraBe 11, D-8700 Wurzburg, F.R.G.Received March 28, 1990; accepted July 12, 1990. Siemens AG, Erlangen, F.R.G.) combined with a special 48-element, 2.25-MHz 90°-sector probe. Real-time (B-mode) sonography was performed with high frameto-frame averaging (ratio of memory information to new information 60% : 40%). Blood flow velocity and direction were displayed in real time as color for every pixel within a selectable subsector of the image. Blood flow toward the probe was displayed as shades of red/yellow and that away from the probe as shades of blue/turquoise. The colors were superimposed on the anatomic black-and-white B-mode image. 5 -7 High temporal and...

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Thirty-six patients with acute spontaneous subarachnoid hemorrhage (26 caused by rupture of an aneurysm) were examined by transcranial color-coded real-time sonography by using a 2.25-MHz ultrasound transducer. In 20 of these 26 patients (76%), the aneurysm could be identified by a characteristic abnormal blood flow pattern within the aneurysm in coronal and axial scanning planes by transcranial color-coded real-time sonography. Blood within the basal cisterns, on top of the tentorium, and within the ventricles and parenchyma was sonographically detected by increased echodensity in 75%. In addition, cerebrospinal fluid circulation disturbances and cerebral vasospasm were detected in two-dimensional B-mode images in 85% and 100%, respectively. In Doppler mode, intravascular blood flow velocity could be quantified. We conclude that transcranial color-coded real-time sonography, a new, noninvasive method for diagnosis and follow-up of patients with subarachnoid hemorrhage, allows detection of the primary vascular lesion and monitoring of complications.

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