DIAGNOSTIC IMPACT AND PROGNOSTIC RELEVANCE OF EARLY CONTRAST-ENHANCEDTRANSCRANIAL COLOR-CODED DUPLEX SONOGRAPHY IN ACUTE STROKE

Background and Purpose-We sought to evaluate the diagnostic value of e cho-enhanced transcranial color-coded duplex sonography (TCCD) and the clinical relevance of vascular pathology assessed by sonography for e arly clinical outcome in acute ischemic stroke. Methods-We present 23 consecutive patients with an anterior circulation stroke in whom clini cal examination, CT, and ultrasonography were performed within 5 hours after the onset of symptoms. Transcranial Doppler sonography (TCD) an d unenhanced and contrast-enhanced TCCD (Levovist, 4 g, 300 mg/mL) wer e compared for their ability to detect middle cerebral artery (MCA) oc clusion and flow velocity reduction suggesting hemodynamic impairment in the MCA distribution pathway, Sonographic examination times were re gistered. Baseline clinical characteristics and CT findings were asses sed. Neurological deficit was quantified according to the National Ins titutes of Health Stroke Scale score, with an early clinical improveme nt defined as decrease of the score by 4 or more points or a complete resolution of the deficit on day 4. Results-Contrast-enhanced TCCD ena bled diagnosis of intracranial vascular pathology in 20 affected hemis pheres, whereas unenhanced TCCD and TCD were conclusive in 7 and 14 he mispheres, respectively (P=0.0001). Contrast-enhanced TCCD was superio r in evaluating distal carotid (carotid-T) occlusion and differentiati ng major vessel occlusions from patent arteries with flow velocity dim inution. Mean examination time for enhanced TCCD ranged from 5 to 7 mi nutes, depending on the number of investigated vessels (without or wit h MCA branches). Logistic regression selected a patent MCA without red uced blood flow velocity as the only independent predictor for an earl y clinical improvement (P<0.01). Conclusions-Contrast-enhanced TCCD is a promising tool for early prognosis in anterior circulation stroke. It is considered superior to unenhanced TCCD and TCD.