Postert T, Braun B, Federlein J, Przuntek H, Köster O, Büttner T
Department of Neurology, Ruhr-University Bochum, Germany.
Ultrasound Med Biol. 1998 Mar;24(3):333-40. doi: 10.1016/s0301-5629(97)00276-7.
Transcranial color-coded real-time sonography (TCCS) is an emerging diagnostic technique that allows noninvasive imaging of intracranial vessels within parenchymal structures. However, in some patients, transcranial ultrasound is particularly hindered by insufficient ultrasound penetration through the temporal bone. The present study evaluates whether or not application of an echo-contrast agent in ultrasound-refractory patients with middle cerebral artery (MCA) trunk occlusion enhances image acquisition enough to yield accurate diagnoses. Contrast-enhanced (CE) TCCS examinations, computed tomography scans and angiographic studies were performed in 20 patients with clinical symptoms suggestive of MCA occlusion within 12 h of the onset of symptoms. For comparison, 20 control persons without history or clinical signs for cerebrovascular diseases were examined using CE-TCCS. In none of the patients or control subjects did unenhanced TCCS investigations depict any color-coded vascular signal of an intracranial vessel. After application of 9 mL of 400 mg/mL galactose-based microbubbles, CE-TCCS was performed. In subjects with MCA occlusion, CE-TCCS examinations were repeated within 24 h, 48 h and 5 days after stroke. In stroke patients (n = 20), CE-TCCS showed an occluded MCA main stem in 11 patients, and this vessel was clearly demonstrable on the unaffected side. On the affected side, the posterior cerebral artery (PCA) and anterior cerebral artery (ACA) could be visualized in 8 of 11 subjects; in 3 patients, at least 1 of these vessels was detectable. Angiographic studies confirmed the diagnosis of MCA trunk occlusion in all 11 individuals. In follow-up investigations, 3 stroke patients had angiographic and CE-TCCS examinations consistent with vessel reperfusion. Nine stroke patients had a patent MCA shown in angiographic and CE-TCCS examinations. In the control group, the MCA trunk could be visualized in all subjects by CE-TCCS. CE-TCCS is a sensitive and specific ultrasound method for the diagnosis of MCA trunk occlusion that overcomes the anatomical hindrance of inadequate acoustic bone window. This technique may help to identify patients suitable for thrombolytic therapies and monitor their response.
经颅彩色编码实时超声检查（TCCS）是一种新兴的诊断技术，可对实质结构内的颅内血管进行无创成像。然而，在一些患者中，经颅超声检查特别受到超声透过颞骨不足的阻碍。本研究评估在超声检查困难的大脑中动脉（MCA）主干闭塞患者中应用超声造影剂是否能增强图像采集，从而做出准确诊断。对20例在症状发作12小时内有提示MCA闭塞临床症状的患者进行了对比增强（CE）TCCS检查、计算机断层扫描和血管造影研究。作为对照，对20名无脑血管疾病病史或临床体征的对照者进行了CE-TCCS检查。在所有患者或对照者中，未增强的TCCS检查均未显示任何颅内血管的彩色编码血管信号。在注入9毫升400毫克/毫升基于半乳糖的微泡后，进行了CE-TCCS检查。对于MCA闭塞的受试者，在中风后24小时、48小时和5天内重复进行CE-TCCS检查。在中风患者（n = 20）中，CE-TCCS显示11例患者的MCA主干闭塞，该血管在未受影响侧清晰可见。在受影响侧，11名受试者中有8名可观察到大脑后动脉（PCA）和大脑前动脉（ACA）；3例患者中，至少可检测到这些血管中的1条。血管造影研究证实所有11例患者均为MCA主干闭塞。在随访研究中，3例中风患者的血管造影和CE-TCCS检查结果与血管再通一致。9例中风患者的血管造影和CE-TCCS检查显示MCA通畅。在对照组中，通过CE-TCCS可在所有受试者中观察到MCA主干。CE-TCCS是一种敏感且特异的超声方法，用于诊断MCA主干闭塞，克服了声学骨窗不足的解剖学障碍。该技术可能有助于识别适合溶栓治疗的患者并监测其反应。
