shu-508 and Cerebral-Infarction

The aim of this study is to assess contrast-enhanced transcranial color-coded duplex sonography (CE-TCCS) diagnosis of basilar artery (BA) stenosis.. CE-TCCS and cerebral angiography were performed in 120 consecutive patients. The patients were angiographically divided into five groups: (1) intracranial arteries (ICA) stenosis but no BA stenosis as intracranial stenosis (ICS) group, (2) both ICA and BA stenoses as internal carotid arteay and basilar arteay stenoses (IBS) group, (3) BA stenosis as basilar artery stenosis (BAS) group, (4) BA occlusion as basilar artery occlusion (BAO) group, and (5) no arterial lesions as Control group. We compared the peak systolic flow velocity (PSV) of BA using CE-TCCS.. PSV was highest in the BAS group (n= 9, 206.1 +/- 118.6 cm/sec), followed by the ICS (n= 27, 74.9 +/- 36.1 cm/sec) and Control (n= 70, 58.2 +/- 17.3 cm/sec) groups. IBS group had two patients (PSV: 102 cm/sec and 167 cm/sec). Sensitivity-specificity curve analysis revealed a cutoff PSV of 120 cm/sec to distinguish the BAS group from other groups, and then we calculated sensitivity of 100%, specificity of 95%, positive predictive value of 64%, negative predictive value of 100%, and accuracy of 95%.. Measurement of PSV of the BA using CE-TCCS is useful for the identification of BA stenosis.

Topics: Aged; Angiography, Digital Subtraction; Blood Flow Velocity; Brain Ischemia; Carotid Stenosis; Cerebral Angiography; Cerebral Hemorrhage; Cerebral Infarction; Contrast Media; Female; Humans; Image Enhancement; Ischemic Attack, Transient; Male; Middle Aged; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Transcranial; Vertebrobasilar Insufficiency

To investigate new methods of diagnostic transcranial sonography for brain parenchymal, vascular and perfusion imaging, we performed 3-D native tissue harmonic transcranial sonography (3D-nthTCS), 3-D transcranial color-coded duplex sonography (3D-TCCS), and "loss-of-correlation" imaging (LOC-TCCS) in four patients following early hemicraniectomy due to space-occupying "malignant" middle cerebral artery infarction (MMCAI). Three-dimensional datasets, utilizing 3D-nthTCS and 3D-TCCS, were created and up to 10 axial 2-D B-mode image planes, similar to CCT, reconstructed in each patient. Three-dimensional reconstructions of the circle of Willis documented one persistent carotid-T occlusion and three recanalizations of the MCA. LOC-TCCS, based on stimulated acoustic emission from an ultrasound (US) contrast agent, demonstrated a perfusion deficit in 2 of 3 patients, with regard to their infarcts. Concluding, 3D-nthTCS, 3D-TCCS and LOC-TCCS are promising tools for bedside monitoring, early prognosis and treatment evaluation for MMCAI in the postoperative period. Further studies should be performed to standardize these new methods and evaluate their applications through the intact calvarina.

Topics: Adult; Cerebral Infarction; Cerebrovascular Circulation; Contrast Media; Craniotomy; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Transcranial

Air microemboli may damage the cerebral microvasculature. The aim of this study was to evaluate the safety of ultrasound contrast agents composed of air microspheres with regard to cerebral damage when administered into the arterial system (ie, when not filtered by the capillary system of the lungs).. Three experimental methods were used in 75 rats after injection of either Albunex, Echovist, or Levovist into the left heart ventricle. The alkaline phosphatase (ALP) method to demonstrate small segmental brain capillary and arteriolar dilatations (SCADs), intravenous injections of Evans blue and fluorescence microscopy to detect increased vascular permeability (blood-brain barrier damage), and histologic examination of the brain to detect microinfarction. Intracardiac injections of saline, air, and corn oil were used as controls.. Brain microinfarcts and SCADs formation of the brain microvasculature occurred only after control injections with corn oil. None of the brains from animals that received ultrasound contrast agent showed gross discoloration, as an indication of increased vascular permeability, with the Evans blue/fluorescence microscopy method. Definite leakage of Evans blue occurred only after large doses (150 microL) of air.. This study indicates that ultrasound contrast media composed of air microspheres do not cause lesions of the brain microvasculature or parenchyma.

Topics: Albumins; Animals; Arterioles; Blood-Brain Barrier; Capillaries; Capillary Permeability; Cerebral Infarction; Cerebrovascular Circulation; Contrast Media; Male; Microspheres; Polysaccharides; Rats; Rats, Wistar; Ultrasonography, Doppler; Vasodilation