Effect of echo contrast media on the visualization of transverse sinus thrombosis with transcranial 3-D duplex sonography

Transcranial duplex sonography has the capacity of detecting venous flow as in the transverse sinus, During a 6-month period, 28 consecutive patients (mean age 55 y) with a clinically suspected diagnosis of cerebral sinus thr ombosis were included in the study. All patients were examined using 3-D ul trasound equipment within 24 h of having undergone either venous computeriz ed tomography (CT), venous magnetic resonance imaging (MRI) or cerebral ang iography. A total of 22 healthy patients had a normal venous CT, venous MRI or cerebral angiography of both transverse sinuses. Before echo contrast e nhancement, the transverse sinus could be visualized in only 2 of these 44 sinuses (22 patients). A total of 6 patients with an unilaterally missed tr ansverse sinus in 3-D ultrasound suffered from sinus thrombosis (n = 3), hy poplasia (n = 2) or aplasia (n = 1) of the unilateral transverse sinus in n euroradiological tests. In none of the patients with an thrombosis of the t ransverse sinus did ultrasound contrast media application improve the visua lization of the affected sinus, Our study confirms that the normal transver se sinus, insonated through the contralateral temporal bone, often cannot b e visualized without the use of contrast agents. With transcranial 3-D dupl ex sonography, a differentiation between thrombosis, hypoplasia and aplasia of the sinus was not possible. (C) 1999 World Federation for Ultrasound in Medicine & Biology.