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Contrast-enhanced transcranial color-coded duplex sonography: efficiency and validity.

T Gerriets1, G Seidel, I Fiss

  • 1Department of Neurology, University at Lübeck, Germany.

Neurology
|April 24, 1999
PubMed
Summary
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Contrast-enhanced transcranial color-coded sonography (CE-TCCS) significantly improves diagnostic accuracy for cerebrovascular patients with poor TCCS windows. This reliable method enhances visualization of basal cerebral arteries, aiding in the detection of stenoses and occlusions.

Area of Science:

  • Neurology
  • Medical Imaging
  • Diagnostic Ultrasound

Background:

  • Transcranial color-coded sonography (TCCS) has limitations in visualizing basal cerebral arteries due to insufficient ultrasonic penetration in approximately 20% of patients.
  • Temporal bone window failure significantly hampers conventional TCCS assessments.

Purpose of the Study:

  • To evaluate the diagnostic efficiency and accuracy of contrast-enhanced transcranial color-coded sonography (CE-TCCS).
  • To determine the impact of ultrasonic contrast agents on the visualization of basal cerebral arteries.

Main Methods:

  • Fifty-nine TCCS examinations were performed on 47 patients with inadequate conventional TCCS assessments, both before and after administering the contrast agent Levovist.
  • Assessability of basal cerebral arteries was evaluated offline, with 11 patients having available angiographic records for comparison.

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Main Results:

  • Contrast enhancement markedly improved the satisfactory investigation rates for the middle cerebral artery (5.1% to 84.7%), anterior cerebral artery (28.8% to 91.5%), posterior cerebral artery segments P1 and P2 (35.6% to 93.2%, 55.9% to 94.5%), and the supraclinoid internal carotid artery siphon (47.5% to 93.2%).
  • Stenoses or occlusions were detected in 28 patients (60%).
  • CE-TCCS diagnosis was confirmed by digital subtraction angiography or magnetic resonance angiography in 10 of 11 patients, yielding positive and negative predictive values of 0.86 and 1.00, respectively.

Conclusions:

  • Contrast enhancement significantly boosts the diagnostic capabilities of TCCS, particularly in patients with temporal bone window failure.
  • CE-TCCS is a reliable method for detecting occlusions and stenoses in the middle cerebral artery and carotid siphon.