[Clinical significance of echocontrast enchancement in neurovascular diagnosis. Review of experience following a year of use].
OBJECTIVE
To evaluate the potential and limitations of echocontrast enhancement using Levovist in a non selected consecutive cohort of neurological patients with insufficient native ultrasound investigations.


METHODS
In 91 patients an indication for echocontrast application was seen after an insufficient extracranial (n = 17), transtemporal (n = 54), and transforaminal (n = 20) Doppler- und color-coded Duplex sonography. Levovist was injected at a concentration of 400 mg/ml and 200-400 mg/ml for the transcranial and extracranial approach, respectively. The effect of the echocontrast enhancement was assessed semiquantitatively with respect to signal enhancement, imaging quality, and diagnostic confidence.


RESULTS
In a total of 83 patients (91%) the signal enhancement led to a moderate to high imaging quality allowing to reach 67 definite neurovascular diagnoses (74%). In subgroup analysis, the amount of sufficiently confident examinations was significantly higher for the transtemporal and transforaminal (both 80%) than for the extracranial approach (47%). The latter was mostly due to artificial signals derived from adjacent neck vessels.


CONCLUSIONS
Levovist constitutes a safe and highly effective diagnostic tool especially for the transtemporal and transforaminal neurosonographical imaging. By means of a differentiated application of echocontrast agents, its cost-effectiveness can be increased and the need for other potential invasive and expansive neuroimaging methods can be further reduced.
Nabavi
D G
DG
Klinik und Poliklinik für Neurologie, Westfälische Wilhelms-Universität, Münster.
Droste
D W
DW
Schulte-Altedorneburg
G
G
Kemény
V
V
Panzica
M
M
Weber
S
S
Ringelstein
E B
EB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000009:adverse effects; D018608:Ultrasonography, Doppler / Q000379:methods
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508
Klinische Bedeutung der Echokontrastverstärkung in der neurovaskulären Diagnostik. Erfahrungsbericht nach einjähriger offener Anwendungsstudie.