CONTRAST-ENHANCED TRANSCRANIAL COLOR-CODED DUPLEX SONOGRAPHY IN ISCHEMIC CEREBROVASCULAR-DISEASE

Background and Purpose Echo contrast agents have been shown to provide conclusive examinations in most patients with insufficient ultrasound penetration through the temporal bone. We investigated the diagnostic value of contrast-enhanced (CE) transcranial color-coded duplex sonog raphy (TCCD) in patients with ischemic cerebrovascular disease and ins ufficient temporal windows and evaluated TCCD criteria that predict wh ether CE-TCCD studies may become conclusive. Methods Thirty-three pati ents presenting with ischemic strokes (n = 21) and transient ischemic attacks (n = 12) were investigated. Extracranial color duplex imaging showed normal findings in 24 patients, eight greater than or equal to 70% stenoses and one occlusion of the carotid arteries in 8 patients, and severe occlusive disease of both vertebral arteries in 1 patient. Seven carotid stenoses and vertebral artery obstructions were confirme d by angiography. The galactose/palmitic acid-based echo contrast agen t was injected intravenously as bolus of 200, 300, or 400 mg/mL in a d osage of 10, 5, and 5 mL, respectively.Results Thirty-two of the 33 pa tients were completely examined because 1 patient who felt pain at the injection site declined further investigations. Twenty-one (66%) of 3 2 CE studies were conclusive and showed cross-flow through three anter ior and two posterior communicating arteries, but no stenoses and occl usions. Precontrast identification of any cerebral artery provided an overall accuracy of 97% in predicting a conclusive CE investigation. P recontrast TCCD identified no arterial Doppler signals in patients wit h inconclusive CE studies. Conclusions CE-TCCD provided conclusive exa minations in two thirds of patients with ischemic cerebrovascular dise ase and ultrasound-refractory temporal windows. Precontrast detection of any cerebral artery reliably predicted a conclusive CE investigatio n.