Gahn G, Gerber J, Hallmeyer S, Hahn G, Ackerman R H, Reichmann H, von Kummer R
Department of Neurology, University of Technology, Dresden, Germany.
AJNR Am J Neuroradiol. 2000 Mar;21(3):509-14.
Thickening of the temporal bone in stroke-age patients may obviate sonographic evaluation of the circle of Willis in 20% to 30% of patients. We assessed the diagnostic efficacy of contrast-enhanced transcranial color-coded duplexsonography (TCCD) for noninvasive evaluation of the circle of Willis in stroke patients with limited bone windows.
Of 171 consecutive patients who presented with ischemic symptoms in the middle cerebral artery (MCA) territory, 49 patients (32 female, 17 male; age range, 70.5+/-10.6 years) had no detectable colorflow signals from the circle of Willis by TCCD because of limited acoustic windows. These 49 patients received an IV injection of a sonographic contrast-enhancing agent, Levovist (Schering; Berlin, Germany), and were re-examined. Correlative imaging studies of the circle of Willis were obtained in 42 of 49 of these patients.
In 38 of 49 patients, contrast-enhanced TCCD enabled full visualization of the circle of Willis bilaterally; in an additional five patients, contrast-enhanced TCCD revealed only the portion of the circle of Willis ipsilateral to the probe through one temporal bone. In six of these 43 patients, contrast-enhanced TCCD showed MCA stenosis and MCA occlusion in three; three of the six cases of MCA stenosis and all three cases of the MCA occlusion were found on the symptomatic side. In six of 49 patients, no colorflow signals were obtained after contrast enhancement. All contrast-enhanced TCCD findings were confirmed by CT angiography, transfemoral digital subtraction angiography, MR angiography, or a combination of all three correlative studies. Levovist produced no serious adverse events.
In stroke-age patients with limited acoustic windows, contrast-enhancement with Levovist can markedly increase the sensitivity of TCCD and increase the detection of clinically relevant intracranial arterial disease.
中风年龄患者的颞骨增厚可能导致20%至30%的患者无法通过超声对 Willis 环进行评估。我们评估了对比增强经颅彩色编码双功能超声（TCCD）对骨窗受限的中风患者 Willis 环进行无创评估的诊断效能。
在171例连续出现大脑中动脉（MCA）区域缺血症状的患者中，49例患者（32例女性，17例男性；年龄范围70.5±10.6岁）由于声窗受限，通过TCCD未检测到 Willis 环的血流信号。这49例患者静脉注射超声造影剂 Levovist（先灵公司；德国柏林）后再次接受检查。其中49例患者中的42例进行了 Willis 环的相关影像学检查。
49例患者中有38例，对比增强TCCD能够双侧完整显示 Willis 环；另有5例患者，对比增强TCCD仅通过一侧颞骨显示了与探头同侧的 Willis 环部分。这43例患者中有6例，对比增强TCCD显示MCA狭窄，其中3例显示MCA闭塞；6例MCA狭窄病例中的3例以及所有3例MCA闭塞病例均在症状侧发现。49例患者中有6例在对比增强后未获得血流信号。所有对比增强TCCD检查结果均经CT血管造影、经股动脉数字减影血管造影、MR血管造影或这三项相关检查联合证实。Levovist未产生严重不良事件。
在声窗受限的中风年龄患者中，使用Levovist进行对比增强可显著提高TCCD的敏感性，并增加对临床相关颅内动脉疾病的检测。
