title: Echo contrast-enhanced transcranial ultrasound: frequency of use, diagnostic benefit, and validity of results compared with MRA.
abstract: OBJECTIVE
  The present study was undertaken to determine the frequency of use of the ultrasound contrast agent (UCA) Levovist in routine transcranial ultrasound (TU). Additionally, we evaluated the diagnostic validity of contrast-enhanced TU using 3-dimensional time of flight MR angiography.
  
  
  METHODS
  Indication for the UCA was an insufficient evaluation of the intracranial arteries after a combined approach with transcranial color-coded Duplex and transcranial Doppler examination. We prospectively analyzed every patient referred for TU over 6 months. Additionally, over a 3-month period, TU results were compared with 3-dimensional time-of-flight MR angiography.
  
  
  RESULTS
  Indication for use of UCA was met in 61 of 687 patients (8.8%). After UCA application, a diagnostic result was achieved in 75% of cases during transtemporal and in 81% during transforaminal insonation. The sensitivity and specificity of TU in the diagnosis of intracranial stenosis were 83% and 82%, respectively.
  
  
  CONCLUSIONS
  Use of UCA was necessary in 8.8% of the patients. A diagnostic benefit was achieved in 75% to 80% of cases. Contrast-enhanced TU demonstrated a high sensitivity and specificity in the diagnosis of intracranial stenosis.
authors.affiliation: Department of Neurology, Kiel University Hospital, Kiel, Germany. peter.zunker@wegmanklinik.ch
authors.forename: Peter
authors.initials: P
authors.lastname: Zunker
authors.forename: Henrik
authors.initials: H
authors.lastname: Wilms
authors.forename: Joachim
authors.initials: J
authors.lastname: Brossmann
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgiadis
authors.forename: Sepp
authors.initials: S
authors.lastname: Weber
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508