shu-508 and Cerebral-Arterial-Diseases

The present study was undertaken to determine the frequency of use of the ultrasound contrast agent (UCA) Levovist in routine transcranial ultrasound (TU). Additionally, we evaluated the diagnostic validity of contrast-enhanced TU using 3-dimensional time of flight MR angiography.. Indication for the UCA was an insufficient evaluation of the intracranial arteries after a combined approach with transcranial color-coded Duplex and transcranial Doppler examination. We prospectively analyzed every patient referred for TU over 6 months. Additionally, over a 3-month period, TU results were compared with 3-dimensional time-of-flight MR angiography.. Indication for use of UCA was met in 61 of 687 patients (8.8%). After UCA application, a diagnostic result was achieved in 75% of cases during transtemporal and in 81% during transforaminal insonation. The sensitivity and specificity of TU in the diagnosis of intracranial stenosis were 83% and 82%, respectively.. Use of UCA was necessary in 8.8% of the patients. A diagnostic benefit was achieved in 75% to 80% of cases. Contrast-enhanced TU demonstrated a high sensitivity and specificity in the diagnosis of intracranial stenosis.

Topics: Aged; Brain; Cerebral Arterial Diseases; Contrast Media; Female; Humans; Image Enhancement; Magnetic Resonance Angiography; Male; Middle Aged; Polysaccharides; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography, Doppler, Transcranial

To determine the magnitude and duration of peripheral vascular and cardiac Doppler signal enhancement after intravenous administration of contrast agent SH U 508A.. Suboptimal cardiac or peripheral vascular Doppler examinations were evaluated. A total of 75 intravenous bolus injections were made in 30 patients. Spectral audio Doppler intensity was measured throughout the duration of contrast effect.. No clinically relevant adverse effects were noted, and Doppler enhancement was apparent in all cases. The diagnostic confidence of the investigators when scored before and after Doppler enhancement improved from 35% to 91% (P < .05). Doppler intensity increased more than 16 dB in all vascular regions investigated (P < .05). The contrast effect lasted for more than 120 seconds in the peripheral vascular and cardiac groups at equivalent doses.. Intravenously administered SH U 508A is effective in markedly increasing cardiac, femoral arterial, and transcranial (cerebral arterial) Doppler signal intensity. The effect improves the clinical diagnostic confidence in cases of suboptimal unenhanced Doppler examinations.

Topics: Cerebral Arterial Diseases; Contrast Media; Echocardiography, Doppler; Female; Femoral Artery; Humans; Injections, Intravenous; Male; Middle Aged; Mitral Valve Insufficiency; Peripheral Vascular Diseases; Polysaccharides; Ultrasonography, Doppler, Transcranial

Treatment of acute ischemic stroke with intravenous recombinant tissue plasminogen activator (rtPA) is relatively ineffective in patients with large vessel occlusion. Numerous experimental studies have demonstrated that ultrasound (US) can accelerate enzymatic fibrinolysis and acceleration of lysis by US is enhanced in the presence of microbubbles used as echo-contrast agents. The purpose of this study was to evaluate the feasibility of continuous monitoring of middle cerebral artery (MCA) recanalization using transcranial color-coded sonography (TCCS) and intravenously administered microbubbles.. Recanalization of middle cerebral artery (MCA) mainstem occlusion was assessed using continuous monitoring with TCCS and intravenously administered galactose-based microbubbles (Levovist) in 8 consecutive patients with acute ischemic stroke treated with intravenous rt-PA within 3 hours of symptom onset.. Recanalization at one hour occurred in 4 of 8 patients. The median NIHSS score was 21 (range 10 to 28) at baseline, 15 (range 0 to 24) at 1 h, and 11 (range 0 to 22) at 24 h. Asymptomatic hemorrhagic transformation (HT) was demonstrated on brain imaging in 6 patients.. This study demonstrates the feasibility of continuous monitoring of MCA recanalization using TCCS and Levovist, in acute stroke patients. The findings suggest a high rate of asymptomatic HT in monitored patients. Although all HTs were asymptomatic and did not preclude early clinical improvement, particular attention should be given to the incidence and clinical significance of HT in future studies using these methods.

Topics: Angioplasty, Balloon; Cerebral Arterial Diseases; Contrast Media; Fibrinolytic Agents; Humans; Infusions, Intravenous; Middle Cerebral Artery; Monitoring, Physiologic; Polysaccharides; Recombinant Proteins; Retrospective Studies; Tissue Plasminogen Activator; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Transcranial

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.

Topics: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Arterial Occlusive Diseases; Brain Ischemia; Cerebral Arterial Diseases; Contrast Media; Female; Follow-Up Studies; Humans; Image Enhancement; Infusions, Intravenous; Magnetic Resonance Angiography; Male; Middle Aged; Polysaccharides; Temporal Bone; Tomography, X-Ray Computed; Ultrasonography, Doppler, Transcranial

This study evaluated intracranial cerebral arteries using a new data acquisition system for transcranial three-dimensional (3D) ultrasonography with and without an echo contrast agent, with confirmation by cerebral angiography. Ten patients, studied with diagnostic cerebral angiography, were examined without knowledge of the angiographic results. Data acquisition through the transtemporal acoustic window was performed using a magnetic sensor system to track the spatial orientation of the ultrasound probe while scanning the volume of interest. A color transcranial duplex system with a power Doppler mode was used, and 3D data sets were acquired before and after the injection of transpulmonary-stable ultrasound contrast medium. Ipsilateral to the transducer, the anterior cerebral artery (ACA) in 90%, middle cerebral artery (MCA) in 60%, all three or more branches of the MCA in 60%, posterior cerebral artery (PCA) in 60%, and posterior communicating artery (PCoA) in 60% were successfully imaged without the echo contrast agent. With the contrast agent, the ACA, MCA, three or more branches of the MCA, PCA, and PCoA were visible in 100%. The anterior communicating artery was visualized in 40% without contrast enhancement and in 90% with contrast enhancement. Contralateral to the transducer, the ACA (60%), MCA (30%), all three or more branches of the MCA (10%), PCA (20%), and PCoA (20%) were successfully imaged without contrast. Contrast enhancement improved the imaging success rate for the ACA (90%), MCA (80%), three or more branches of the MCA (80%), PCA (100%), and PCoA (100%). A transpulmonary-stable ultrasound contrast agent used in combination with 3D transcranial duplex ultrasonography can significantly improve the success rate for transcranial color duplex imaging of intracranial arteries.

Topics: Adult; Carotid Stenosis; Cerebral Angiography; Cerebral Arterial Diseases; Contrast Media; Female; Humans; Image Processing, Computer-Assisted; Male; Polysaccharides; Ultrasonography, Doppler, Transcranial