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Contrast-enhanced transcranial color-coded duplexsonography in stroke patients with limited bone windows.
G Gahn1, J Gerber, S Hallmeyer
1Department of Neurology, University of Technology, Dresden, Germany.
AJNR. American Journal of Neuroradiology
|March 24, 2000
Summary
Contrast-enhanced transcranial color-coded duplex sonography (TCCD) improves visualization of the circle of Willis in stroke patients with difficult bone windows. This technique enhances detection of intracranial arterial disease, aiding stroke diagnosis.
Area of Science:
- Neurology
- Medical Imaging
- Vascular Ultrasound
Background:
- Temporal bone thickening limits circle of Willis evaluation in 20-30% of stroke patients via standard TCCD.
- Limited acoustic windows pose a challenge for noninvasive stroke diagnosis.
Purpose of the Study:
- To assess the diagnostic efficacy of contrast-enhanced transcranial color-coded duplex sonography (TCCD) for evaluating the circle of Willis in stroke patients with poor bone windows.
- To determine if contrast agents improve TCCD's ability to detect intracranial arterial disease.
Main Methods:
- 49 stroke patients with undetectable circle of Willis signals by TCCD due to limited acoustic windows were studied.
- These patients received intravenous Levovist (contrast agent) for enhanced TCCD re-examination.
- Correlative imaging (CTA, DSA, MRA) was performed in 42 patients.
Main Results:
- Contrast-enhanced TCCD achieved full bilateral circle of Willis visualization in 38 of 49 patients.
- Partial visualization was achieved in 5 additional patients.
- Significant findings included MCA stenosis and occlusion, confirmed by correlative studies. No serious adverse events were reported with Levovist.
Conclusions:
- Contrast enhancement with Levovist significantly increases TCCD sensitivity in stroke patients with limited acoustic windows.
- This method improves the detection of clinically relevant intracranial arterial disease, aiding stroke management.