title: Contrast-enhanced transcranial color-coded duplex sonography in ischemic cerebrovascular disease.
abstract: OBJECTIVE
  Echo contrast agents have been shown to provide conclusive examinations in most patients with insufficient ultrasound penetration through the temporal bone. We investigated the diagnostic value of contrast-enhanced (CE) transcranial color-coded duplex sonography (TCCD) in patients with ischemic cerebrovascular disease and insufficient temporal windows and evaluated TCCD criteria that predict whether CE-TCCD studies may become conclusive.
  
  
  METHODS
  Thirty-three patients presenting with ischemic strokes (n = 21) and transient ischemic attacks (n = 12) were investigated. Extracranial color duplex imaging showed normal findings in 24 patients, eight > or = 70% stenoses and one occlusion of the carotid arteries in 8 patients, and severe occlusive disease of both vertebral arteries in 1 patient. Seven carotid stenoses and vertebral artery obstructions were confirmed by angiography. The galactose/palmitic acid-based echo contrast agent was injected intravenously as bolus of 200, 300, or 400 mg/mL in a dosage of 10, 5, and 5 mL, respectively.
  
  
  RESULTS
  Thirty-two of the 33 patients were completely examined because 1 patient who felt pain at the injection site declined further investigations. Twenty-one (66%) of 32 CE studies were conclusive and showed cross-flow through three anterior and two posterior communicating arteries, but no stenoses and occlusions. Precontrast identification of any cerebral artery provided an overall accuracy of 97% in predicting a conclusive CE investigation. Precontrast TCCD identified no arterial Doppler signals in patients with inconclusive CE studies.
  
  
  CONCLUSIONS
  CE-TCCD provided conclusive examinations in two thirds of patients with ischemic cerebrovascular disease and ultrasound-refractory temporal windows. Precontrast detection of any cerebral artery reliably predicted a conclusive CE investigation.
authors.affiliation: Department of Neurology, University Hospital, Bern, Switzerland. Strusbmg@neurol.unizh.ch
authors.forename: R W
authors.initials: RW
authors.lastname: Baumgartner
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: F
authors.initials: F
authors.lastname: Gönner
authors.forename: I
authors.initials: I
authors.lastname: Staikow
authors.forename: C
authors.initials: C
authors.lastname: Herrmann
authors.forename: A
authors.initials: A
authors.lastname: Rivoir
authors.forename: R M
authors.initials: RM
authors.lastname: Müri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D013599:Systole; D014463:Ultrasonography / Q000379:methods* / Q000592:standards
chemical_list: D003287:Contrast Media