Echocontrast enhanced transcranial colour-coded duplex offers improved visualization of the vertebrobasilar system

By means of transcranial colour-coded duplex sonography (TCCD) through the foramen magnum, the intracranial vertebral arteries (VAs) and the basilar artery (BA) can be investigated. In this study we evaluated the additional diagnostic value of echocontrast administration in patients with an insufficient pre-contrast TCCD investigation of the vertebrobasilar system.

In 22 patients the intracranial VAs and the proximal, middle and distal BA were evaluated before and after the application of 4 g of the echocontrast agent Levovist. The length of the different vessel segments visualized on colour mode before and after echocontrast, and the diagnostic benefit and the diagnostic confidence were assessed.

Echocontrast enlarged in each vessel segment the length that could be visualized. Using echocontrast, in 5/22 patients (23%) definite and probable pathological findings unnoted in the native scans were detected. In 12 additional patients (55%) the investigator and the clinician became confident with the vascular diagnosis by echocontrast to a degree that angiography could be avoided. In only 3/22 patients (14%) no gain and in 2/22 patients (9%) an insufficient diagnostic gain was noted.

Our study demonstrates that echocontrast provides effective Doppler signal enhancement and considerably increases the diagnostic gain of TCCD in the intracranial vertebral and basilar vasculature.