Potential and Limitations of Transcranial Color-Coded Sonography in Stroke Patients

Seidel, Günter; Kaps, Manfred; Gerriets, Tibo

doi:10.1161/01.str.26.11.2061

Cited by 150 publications

(125 citation statements)

References 14 publications

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“…The percentage of patients requiring UCA enhancement in the present study is markedly lower compared with a previous report 14 that analyzed the number of acute stroke patients in whom UCA was necessary for TCCD examination (8.8% versus 20%, respectively). Several reasons may have contributed to this discrepancy.…”

Section: Discussioncontrasting

confidence: 84%

Echo Contrast–Enhanced Transcranial Ultrasound

Zunker

Wilms

Brossmann

et al. 2002

Stroke

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Background and Purpose-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.

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Section: Discussioncontrasting

confidence: 84%

Echo Contrast–Enhanced Transcranial Ultrasound

Zunker

Wilms

Brossmann

et al. 2002

Stroke

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“…43,44 Nevertheless, the use of sonographic contrast agents has been shown to increase significantly the number of valid sonographic investigations and should be kept in mind as an additional option in these patients. 45 Sonographic contrast agents improve detection of maximum flow velocities, which has to be kept in mind when applying our established data.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Valaikienė¹,

Schuierer²,

Ziemus³

et al. 2008

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Gradation of high-grade intracranial internal carotid artery (ICA) stenosis poses a challenge to noninvasive neurovascular imaging, which seems critical for angioplasty in the ICA segments C1 and C5. We investigated cutoff values of intracranial ICA stenosis for transcranial color-coded sonography (TCCS) and compared this method with the "gold standard," digital subtraction angiography (DSA).

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“…According to conventional ce-TCDS studies, failure to perform the transcranial examination has been reported in up to 40% of cases. 14,15 The problem of an insufficient acoustic bone window for the ce-TCDS detection of RLS can be virtually solved by performing extracranial carotid duplex sonography. We made use of pulse inversion-based contrast-enhanced harmonic imaging, which enables the visualization of single UCA microbubbles in the vessel lumen because of their nonlinear backscatter.…”

Section: Discussionmentioning

confidence: 99%

Detection of Cardiac Right-to-Left Shunts by Contrast-Enhanced Harmonic Carotid Duplex Sonography

Draganski

Blersch²,

Holmer³

et al. 2005

Journal of Ultrasound in Medicine

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Objective Paradoxical embolization by cardiac right‐to‐left shunts (RLS) is increasingly recognized as an important factor for embolic stroke. Contrast‐enhanced transcranial Doppler sonography (ce‐TCDS) is an established diagnostic tool for RLS detection but is frequently limited because of an inadequate temporal acoustic bone window. The purpose of this study was to determine whether extracranial sonography (ECS) using harmonic frequencies improves detection of RLS. Methods Extracranial color duplex sonography using harmonic frequencies enables visualization of even single ultrasound contrast agent microbubbles because of oscillation. Patients with stroke and positive RLS findings on transesophageal echocardiography underwent a simultaneous extracranial and transcranial sonographic examination of the proximal common carotid artery (CCA) and middle cerebral artery (MCA) on the same side. A Valsalva strain was performed for 10 seconds after intravenous bolus injection of a galactose‐based nontranspulmonary contrast agent. The B‐mode frame sequences of the transverse plane of the CCA obtained by harmonic ECS and the ce‐TCDS recordings of high‐intensity transient signals from the MCA were analyzed offline. Results In all patients with RLS, the shunts could be identified by harmonic ECS. A close correlation could be seen between the count of visualized microbubbles in the CCA and the number of high‐intensity transient signals detected on ce‐TCDS in the ipsilateral MCA. Conclusions The results of this study indicate that contrast‐enhanced ultrasound harmonic imaging of the CCA using a Valsalva strain might be an optional screening tool for detection of cardiac RLS in patients with insufficient acoustic bone windows.

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Potential and Limitations of Transcranial Color-Coded Sonography in Stroke Patients

Abstract: TCCS is a noninvasive bedside method that provides rapid and reliable data regarding stroke subtype and mechanism immediately after onset. Window failure is a serious limitation of this method.

Cited by 150 publications

References 14 publications

Echo Contrast–Enhanced Transcranial Ultrasound

Echo Contrast–Enhanced Transcranial Ultrasound

Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Detection of Cardiac Right-to-Left Shunts by Contrast-Enhanced Harmonic Carotid Duplex Sonography

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