Ultrasound Contrast Agents in Ischemic Stroke

Seidel, Günter; Meairs, Stephen

doi:10.1159/000203124

Cited by 48 publications

(31 citation statements)

References 141 publications

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“…The addition of an ultrasound contrast agent allows adequate diagnosis in about 80–90% of patients with insufficient bone windows [12,13,14,15,16,17,18,19,20]. In our Japanese stroke patients, 40% of TBWs had an improved detection of the M1 on contrast-enhanced examination.…”

Section: Discussionmentioning

confidence: 91%

Visibility of the Lesser Sphenoid Wing Is an Important Indicator for Detecting the Middle Cerebral Artery on Transcranial Color-Coded Sonography

Suzuki¹,

Koga

Mori³

et al. 2012

Cerebrovasc Dis

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Background: Failure to detect the sphenoidal segment of the middle cerebral artery (M1) on transcranial color-coded sonography (TCCS) results from either M1 occlusion or an insufficient temporal bone window (TBW). We sought to identify a simple indicator on B mode images for M1 evaluation. Methods: Consecutive acute ischemic stroke patients with an intact M1 segment underwent prospective TCCS evaluation. Visibilities of the contralateral temporal bone (CTB), midbrain (MB) and lesser sphenoid wing (LSW) on B mode images were defined as follows: ‘invisible’, ‘poor’ if the contour was less than 50% visible, ‘fair’ if more than 50% visible and ‘good’ if totally visible. M1 detectability on color Doppler images was defined as follows: ‘INVISIBLE’, ‘POOR’ if the M1 was detected as color dots, ‘FAIR’ if linearly but discontinuously detectable, and ‘GOOD’ if linearly and continuously detectable. The relationship between each structure’s visibility and M1 detectability was assessed. Results: Seventy-six patients with 152 TBWs were evaluated. The CTB was ‘invisible’ in 2%, ‘poor’ in 22%, ‘fair’ in 36% and ‘good’ in 40%. Visibility of the MB was 36, 24, 26 and 14%, respectively. Visibility of the LSW was 16, 22, 29 and 32%, respectively. The M1 was ‘INVISIBLE’ in 51%, ‘POOR’ in 7%, ‘FAIR’ in 7% and ‘GOOD’ in 35%. Spearman’s rank correlation coefficient between each structure’s visibility and M1 detectability was 0.68 for the CTB, 0.66 for the MB and 0.80 for the LSW, respectively (p < 0.001 for all). Conclusion: Visibility of the LSW on B mode appears to be a better indicator than other structures for M1 evaluation.

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Section: Discussionmentioning

confidence: 91%

Visibility of the Lesser Sphenoid Wing Is an Important Indicator for Detecting the Middle Cerebral Artery on Transcranial Color-Coded Sonography

Suzuki¹,

Koga

Mori³

et al. 2012

Cerebrovasc Dis

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“…Optional use of an ultrasound contrast agent (SonoVue®, Bracco Imaging SpA, Milan, Italy) allowed us to increase our diagnostic confidence in cases of inferior transcranial bone windows and to save examination time [12]; it also proved valuable during examinations made difficult during emergency transport. Intravenous injections of 0.5–2 ml contrast agent were administered, depending on the quality of the temporal bone window as previously described [13].…”

Section: Methodsmentioning

confidence: 99%

Transcranial Ultrasound from Diagnosis to Early Stroke Treatment – Part 2: Prehospital Neurosonography in Patients with Acute Stroke – The Regensburg Stroke Mobile Project

et al. 2012

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Background and Purpose: The primary aim of this study was to investigate the diagnostic accuracy and time frames for neurological and transcranial color-coded sonography (TCCS) assessments in a prehospital ‘911’ emergency stroke situation by using portable duplex ultrasound devices to visualize the bilateral middle cerebral arteries (MCAs). Methods: This study was conducted between May 2010 and January 2011. Patients who had sustained strokes in the city of Regensburg and the surrounding area in Bavaria, Germany, were enrolled in the study. After a ‘911 stroke code’ call had been dispatched, stroke neurologists with expertise in ultrasonography rendezvoused with the paramedic team at the site of the emergency. After a brief neurological assessment had been completed, the patients underwent TCCS with optional administration of an ultrasound contrast agent in cases of insufficient temporal bone windows or if the agent had acute therapeutic relevance. The ultrasound studies were performed at the site of the emergency or in the ambulance during patient transport to the admitting hospital. Relevant timelines, such as the time from the stroke alarm to patient arrival at the hospital and the duration of the TCCS, were documented, and positive and negative predictive values for the diagnosis of major MCA occlusion were assessed. Results: A total of 113 patients were enrolled in the study. MCA occlusion was diagnosed in 10 patients. In 9 of these 10 patients, MCA occlusion could be visualized using contrast-enhanced or non-contrast-enhanced TCCS during patient transport and was later confirmed using computed tomography or magnetic resonance angiography. One MCA occlusion was missed by TCCS and 1 atypical hemorrhage was misdiagnosed. Overall, the sensitivity of a ‘field diagnosis’ of MCA occlusion was 90% [95% confidence interval (CI) 55.5–99.75%] and the specificity was 98% (95% CI 92.89–99.97%). The positive predictive value was 90% (95% CI 55.5–99.75%) and the negative predictive value was 98% (95% CI 92.89–99.97%). The mean time (standard deviation) from ambulance dispatch to arrival at the patient was 12.3 min (7.09); the mean time for the TCCS examination was 5.6 min (2.2); and the overall mean transport time to the hospital was 53 min (18). Conclusion: Prehospital diagnosis of MCA occlusion in stroke patients is feasible using portable duplex ultrasonography with or without administration of a microbubble contrast agent. Prehospital neurological as well as transcranial vascular assessments during patient transport can be performed by a trained neurologist with high sensitivity and specificity, perhaps opening an additional therapeutic window for sonothrombolysis or neuroprotective strategies.

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“…In transcranial applications, however, some patients' temporal windows are impenetrable without a contrast agent due to attenuation by the skull. Many researchers have found that the use of a contrast agent can salvage most otherwise non-diagnostic exams so that a diagnosis may be made for virtually all patients [16].…”

Section: Doppler-based Techniquesmentioning

confidence: 99%

Principles of Cerebral Ultrasound Contrast Imaging

Powers

Averkiou²

2014

Translational Neurosonology

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Ultrasound contrast is gaining acceptance worldwide as an adjunct to conventional ultrasound imaging. It has clinical applications as diverse as liver disease detection and characterization, myocardial perfusion and wall motion studies, and imaging of cerebral vascularity and perfusion. This paper will focus on imaging techniques used for transcranial ultrasound contrast imaging. The interaction of ultrasound with the microbubbles in the contrast agent is complex and nonlinear. This has led to the development of a variety of imaging modes to improve contrast detection compared with non-contrast optimized modes. This article presents several of these imaging methods in such a way as to help users of ultrasound contrast in the clinic and in research to understand this rapidly developing field.

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Ultrasound Contrast Agents in Ischemic Stroke

Cited by 48 publications

References 141 publications

Visibility of the Lesser Sphenoid Wing Is an Important Indicator for Detecting the Middle Cerebral Artery on Transcranial Color-Coded Sonography

Visibility of the Lesser Sphenoid Wing Is an Important Indicator for Detecting the Middle Cerebral Artery on Transcranial Color-Coded Sonography

Transcranial Ultrasound from Diagnosis to Early Stroke Treatment – Part 2: Prehospital Neurosonography in Patients with Acute Stroke – The Regensburg Stroke Mobile Project

Principles of Cerebral Ultrasound Contrast Imaging

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