Comparison of brain vessel imaging from transtemporal and transcondylar approaches using contrast-enhanced transcranial color-coded duplex sonography and Virtual Navigator

Abstract

Aims. The transcondylar approach is a new and used for detection of chronic cerebro-spinal venous insufficiency (CCSVI) and intracranial venous reflux in patients with multiple sclerosis. The aim of this study was to assess the ability of native and contrast enhanced (CE-) transcranial color-coded duplex sonography (TCCS) to detect flow and reflux in deep cerebral veins and intracranial venous sinuses from transcondylar and transtemporal approaches. Methods. Brain magnetic resonance imaging and TCCS from transtemporal and transcondylar approaches using the new technology -Fusion Imaging -in 8 volunteers and 5 patients with multiple sclerosis. Results. Using TCCS and CE-TCCS, the arteries of the circle of Willis could be detected from the transtemporal approach in 13/13 subjects in both examinations, while detection of the venous system was possible in 7/13 and 9/13 subjects, respectively. However, the arteries of the circle of Willis and venous system were detected through the transcondylar approach in only 5/13 (P=0.041) and 1/13 (P=0.031) subjects using TCCS, and in 12/13 (P=0.921) and 7/13 (P=0.687) subjects using CE-TCCS, respectively. Conclusions. The results reveal that the TCCS transcondylar approach has serious limitations for the standard detection of intracranial venous reflux.