Stolz Erwin, Nückel Martin, Mendes Irene, Gerriets Tibo, Kaps Manfred
Department of Neurology, Justus-Liebig-University, Giessen Germany.
AJNR Am J Neuroradiol. 2002 Jun-Jul;23(6):1051-4.
The diagnostic yield of vertebrobasilar transcranial color-coded duplex ultrasonography (US) is often hampered by insufficient acoustic penetration, anatomic variations, and vessel tortousity. The purpose of this study was to evaluate the effect of echo enhancement on vertebrobasilar transcranial color-coded duplex US.
In 23 consecutive patients (mean age, 61.0 +/- 11.1 years) with vertebrobasilar stroke, the vertebrobasilar system (P1 segment of the posterior cerebral artery [PCA], basilar head, V4 segment of the vertebral artery, and basilar artery) was examined with transcranial color-coded duplex US before and after injection of an echo-enhancer. The acoustic window was graded according to visibility of parenchymal structures, and vessel imaging was graded according to the appearance of the color mode signal. Maximum depth of the basilar color signal was recorded. All patients with an abnormal or inconclusive US finding underwent either digital subtraction angiography or MR angiography.
In the P1 PCA, V4 vertebral artery, basilar artery, and basilar head, image quality was insufficient in 65%, 82%, 83%, and 38%, respectively, before echo enhancement, and in 15%, 30%, 35%, and 9%, respectively, after echo enhancement. In all graded vessels, the improved image quality with echo enhancement was statistically significant. Compared with the reference examinations in the 15 cases of occlusion or stenosis, definite diagnosis was possible in 60% (nine cases) with nonenhanced transcranial color-coded duplex US and in 93% of (14 cases) after echo enhancement.
Echo enhancement resulted in improved image quality of the vertebrobasilar system and markedly increased diagnostic confidence.
椎基底动脉经颅彩色编码双功能超声检查（US）的诊断率常常受到声穿透不足、解剖变异及血管迂曲的影响。本研究旨在评估回声增强对椎基底动脉经颅彩色编码双功能US的影响。
对23例连续性椎基底动脉卒中患者（平均年龄61.0±11.1岁），在注射回声增强剂前后，用经颅彩色编码双功能US检查椎基底动脉系统（大脑后动脉[PCA]的P1段、基底动脉起始部、椎动脉V4段及基底动脉）。根据实质结构的可见性对声窗进行分级，根据彩色模式信号的表现对血管成像进行分级。记录基底动脉彩色信号的最大深度。所有US检查结果异常或不确定的患者均接受数字减影血管造影或磁共振血管造影检查。
在P1段PCA、V4段椎动脉、基底动脉及基底动脉起始部，回声增强前图像质量不足的分别占65%、82%、83%和38%，回声增强后分别占15%、30%、35%和9%。在所有分级血管中，回声增强后图像质量改善具有统计学意义。与15例闭塞或狭窄患者的参考检查相比，未增强的经颅彩色编码双功能US确诊率为60%（9例），回声增强后为93%（14例）。
回声增强可改善椎基底动脉系统的图像质量，并显著提高诊断可信度。
