shu-508 and Intracranial-Aneurysm

Two pilot studies on a small number of patients demonstrated the feasibility of transcranial Doppler ultrasound evaluation in the follow-up of intracranial aneurysms treated with detachable coils. This prospective study aimed to assess the sensitivity of contrast-enhanced transcranial echo-Doppler in detecting partial aneurysmal occlusion following endovascular treatment. Transcranial Doppler sonography (TCD) with contrast administration and magnetic resonance angiography (MRA) or angiography were carried out after endovascular treatment in 92 patients for 98 aneurysms of the anterior circulation. In 18% of cases, the quality of ultrasound exploration was deemed unsatisfactory for evaluation of the aneurysmal site. Results were concordant in 63% of patients (49/78). When occlusion appeared satisfactory at angiography or MRA, the result was concordant with TCD in 68% of cases (44/77). When a residual aneurysm was detected, TCD sensitivity was 38% (8/18). An analysis of subgroups failed to disclose anatomic or morphological aneurysm features in which transcranial echo-Doppler is sufficiently sensitive and specific to detect possible residual aneurysm or recanalisation. In our experience, even after contrast administration TCD is not sufficiently sensitive or specific in the detection of residual aneurysm to replace angiography or MRA.

Topics: Adult; Aged; Contrast Media; Embolization, Therapeutic; Female; Follow-Up Studies; Humans; Image Enhancement; Intracranial Aneurysm; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Treatment Outcome; Ultrasonography, Doppler, Transcranial

The role of 2-dimensional transcranial color-coded sonography (2D-TCCS) as a diagnostic tool in cases of vascular alteration is unquestioned. The skill of the operator, however, may be responsible for some intertrial variability. The clinical value of a new, workstation-based, 3D reconstruction system for TCCS was evaluated in patients with intracranial aneurysms.. Thirty patients with 30 intracranial aneurysms were investigated (8 men, 22 women; mean+/-SD age 54+/-17 years). The TCCS examinations were performed with a 2-MHz probe using the power mode. The 3D system (3D-Echotech, Germany) consisted of an electromagnet, which induced a low-intensity magnetic field near the head of the patient. A magnetic position sensor was attached to the ultrasound probe and transmitted the spatial orientation of the probe to a workstation, which also received the corresponding 2D-images from the video-port of the duplex machine. The echo contrast enhancer D-galactose (Levovist, Schering, Germany) was used in all patients to improve the signal-to-noise ratio. All patients underwent presurgical digital subtraction angiography (DSA) to demonstrate the aneurysm.. Twenty-nine of 30 angiographically proven intracranial aneurysms (97%) were detected by 3D-TCCS. The aneurysmal diameter estimated by DSA ranged from 3 to 16 mm (mean 7. 2+/-3.6 mm). A comparison of the 3 main diameters of each aneurysm revealed a correlation coefficient of 0.95 between DSA and 3D-TCCS. The 3D determination of the aneurysmal size by 2 experienced sonographers correlated with 0.96.. 3D-TCCS is a new, noninvasive method to investigate intracranial aneurysms. The differentiation between artifacts and true changes of the vessel anatomy is much easier in 3D-TCCS than in conventional 2D-TCCS. The new method yields an excellent correlation with the gold standard, DSA. Because the same 3D-TCCS data can be postprocessed by different investigators, it may be possible to improve reproducibility and increase the objectivity of transcranial color-coded duplex sonography.

Topics: Angiography, Digital Subtraction; Artifacts; Computer Systems; Contrast Media; Electromagnetic Phenomena; Female; Galactose; Humans; Image Processing, Computer-Assisted; Intracranial Aneurysm; Male; Middle Aged; Observer Variation; Polysaccharides; Reproducibility of Results; Signal Processing, Computer-Assisted; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Transcranial; Video Recording

The application of different color-coding techniques in transcranial color-coded duplex sonography (TCCD) was assessed for detection and measurement of the size of intracranial aneurysms. Thirty-two consecutively examined patients with 36 angiographically verified cerebral aneurysms underwent TCCD with color Doppler flow imaging (CDFI), power Doppler imaging (PDI), and both methods with contrast enhancement. The diameters of the aneurysms were measured in comparable planes by means of angiography and TCCD-PD with and without 400 mg/ml of the monosaccharide microparticle contrast agent Levovist. TCCD with CFD enabled detection of 27 of 36 aneurysms (75%), and PD depicted 29 aneurysms (80%). After administration of Levovist, an additional two aneurysms were detected with CFD and three with PD color coding. Measurements of aneurysm size obtained by means of PD with contrast enhancement corresponded more highly with angiographic findings than did measurements obtained with PD alone. Use of alternative color-coding techniques with the addition of contrast agents increases the number of intracranial nonthrombosed aneurysms detectable with TCCD.

Topics: Adolescent; Adult; Aged; Contrast Media; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Transcranial