Transcranial color-coded duplex sonography

Transcranial color-coded duplex sonography (TCCS) enables the reliable asse ssment of intracranial stenoses, occlusions, and cross flow through the cir cle of Willis without using potentially hazardous compression tests. Transp ulmonary ultrasound contrast agents (UCAs) increase the number of-conclusiv e TCCS investigations, which suggests that UCAs may provide the conclusive evaluation of intracranial arteries in most patients with ischemic cerebrov ascular disease. Further, contrast-enhanced TCCS may become an important to ol both for the management of acute ischemic stroke by assessing intracrani al hemodynamics and the displacement and diameter changes in supratentorial ventricles. TCCS is useful for the detection and monitoring of intracrania l vasospasm, may visualize larger supratentorial hematomas with sub-cortica l location and hemorrhagic transformation of ischemic infarcts, and provide s the incidental detection of cerebral aneurysms and arteriovenous malforma tions. Second-generation UCAs and new ultrasound machines are very likely t o further increase the frequency of conclusive TCCS studies. Power-based th ree-dimensional, contrast-enhanced TCCS is an important further development , which would make the method much less operator dependent. Site-targeted U CAs appear to provide a new and exciting method for ultrasonic diagnosis an d management of patients with ischemic cerebrovascular disease.