Echo Contrast–Enhanced Transcranial Ultrasound

Zunker, P.; Wilms, Henrik; Brossmann, Joachim; Georgiadis, Dimitrios; Weber, Sepp; Deuschl, Günther

doi:10.1161/01.str.0000035285.43467.ff

Cited by 34 publications

(16 citation statements)

References 23 publications

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“…A significantly higher number of arteries and longer arterial segments could be visualized on color mode with the use of contrast medium. The results of the present study are in accordance with the recent literature [3, 6, 7, 11,13,14,15,16,17,18,19]. …”

Section: Discussionsupporting

confidence: 93%

Benefit of Echocontrast-Enhanced Transcranial Arterial Color-Coded Duplex Ultrasound

et al. 2005

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Objectives: Proper assessment of the intracranial arteries by transcranial color-coded duplex sonography (TCCD) is occasionally made difficult by an insufficient temporal bone window, an unfavorable insonation angle, or low flow velocity or volume. In these cases, echocontrast could be helpful to increase the diagnostic confidence or to make the diagnosis at all. Material and Methods:We investigated 67 temporal windows of 47 patients with insufficient native transtemporal insonation conditions before and after the application of the second-generation (gas-filled) microbubble contrast agent Sonovue^® (in 20 patients out of these 47, both temporal windows were insufficient, in the remaining 27 only one side). Results: As compared to the precontrast scans, echocontrast allowed for more segments to be evaluated by pulsed Doppler sonography (p < 0.0001) and for longer lumen segments to be displayed on color mode (p < 0.0001). With the help of contrast medium, flow velocity in the middle cerebral artery could be measured through 65 windows as compared to only 26 windows before contrast was applied (p < 0.0001). Conclusions: In patients with poor precontrast visualization of intracranial arteries, echocontrast-enhanced TCCD is very helpful.

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Section: Discussionsupporting

confidence: 93%

Benefit of Echocontrast-Enhanced Transcranial Arterial Color-Coded Duplex Ultrasound

et al. 2005

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“…First, our study was limited to patients aged under 55 years because the acoustic temporal bone window is more restricted in the elderly, notably women [16]. Second, the use of contrast enhancement, the benefits of which have been proven [17], was more frequently needed than in most reports (52 vs. 30%) [18]. Third, the investigations were carried out using power-Doppler, the most angle-independent imaging technique, which is more appropriate than color-Doppler for morphological studies on arteries [19, 20].…”

Section: Discussionmentioning

confidence: 99%

“…They highlighted the ability of TCCS to analyze the distal part of the M1 segment, despite potential difficulties such as insonation angle and a more superficial situation [16, 18]. The main technical limitation we encountered (11/23) was an unfavorable angle between the ultrasound beam and the division branches of the M1 segment, which lead to an unfavorable insonation angle.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Course and Division Patterns of the Middle Cerebral Artery M1 Segment

et al. 2008

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Background and Purpose: The present study was undertaken to assess the ability of bedside transcranial color-coded sonography (TCCS) to define the course and the patterns of the division of the middle cerebral artery (MCA) M1 segment compared with 3D time-of-flight magnetic resonance angiography (MRA) at 3 T. Methods: Because MRA is considered as a reliable noninvasive technique to depict the normal anatomy of the intracranial artery, we prospectively defined the course and the patterns of division of 100 MCA M1 segments using bedside TCCS and compared the results with MRA findings. Results: In 68/85 cases (80%), the sonographer was able to define the division of the M1 segment, and classified these as bipode for 50/68 (73.5%), monopode for 16/68 (23.5%) and tripode for 2/68 (3%). A comparison of the TCCS and MRA findings showed a perfect correlation (100%) for the course of the M1 segment. As for the type of division, the correlation was good in 45/68 of cases (67%). TCCS had a sensitivity of 78%, a specificity of 67%, a positive predictive value of 87% and a negative predictive value of 52%, when used to determine whether the division was bipode or not. Conclusions: Our results show that bedside TCCS can now provide anatomical information on the M1 segment of the MCA.

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“…In Europe, the use of echocontrast agents is indicated in approximately 20% of all TCCD investigations [7, 14, 15], and this number may be even higher in patients of Asian or African descent [16]. Echocontrast agents can also be used during conventional continuous wave and transcranial Doppler ultrasound [16], but are of particular benefit in TCCD investigations.…”

Section: Clinical Benefits Of Contrast Applicationmentioning

confidence: 99%

Clinical Utility of Contrast-Enhanced Ultrasound in Neurosonology

Droste

2008

Eur Neurol

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Extracranial and transcranial colour-coded duplex sonography (TCCD) are used routinely in clinical practice to assess physiologic and pathologic arterial blood flow to the brain. Such investigations are straightforward, safe, and cost effective, and can be repeated frequently for patient follow-up. In addition, the portability of extracranial colour-coded duplex sonography and TCCD provides the option of bedside investigations, particularly useful for evaluation of the critically ill patient. However, duplex ultrasound can be hampered by insufficient acoustic penetration, an unfavourable insonation angle, or by conditions of low or no flow. Echocontrast agents capable of surviving pulmonary and capillary transit have been developed, and such agents increase the Doppler signal and, therefore, the success rate of neurosonographic investigations. Approximately 20% of TCCD studies involve poor insonation conditions and, therefore, the use of echocontrast agents is of particular interest for this application. Levovist® and SonoVue® are the two agents currently approved for use in neurosonography. Such agents have a relatively long-lasting effect (up to 7 min), and can be administered as a single injection or, alternatively, a fractionated injection protocol can be used, depending on the quality of the window.

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Echo Contrast–Enhanced Transcranial Ultrasound

Cited by 34 publications

References 23 publications

Benefit of Echocontrast-Enhanced Transcranial Arterial Color-Coded Duplex Ultrasound

Benefit of Echocontrast-Enhanced Transcranial Arterial Color-Coded Duplex Ultrasound

Assessment of the Course and Division Patterns of the Middle Cerebral Artery M1 Segment

Clinical Utility of Contrast-Enhanced Ultrasound in Neurosonology

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