shu-508 and Vascular-Diseases

Twelve patients with insufficient transcranial Doppler signal underwent transcranial color-coded ultrasonography before and after administration of SH U 508A with different modes of administration. Clinically useful enhancement time after bolus injection was surpassed by that after standard infusion (1 mL/min), whereas further prolongation was observed after individualized infusion. Intravenous infusion of SH U 508A provides a prolonged useful enhancement compared with that after bolus injection.

Topics: Contrast Media; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Middle Aged; Polysaccharides; Time Factors; Ultrasonography, Doppler, Transcranial; Vascular Diseases

Pulsed color Doppler imaging of cerebrovascular structures permits rapid visual identification of the intracranial vessels. In some patients, however, the clinical utility of transcranial ultrasound examinations is limited by poor tissue penetration and inadequate imaging of vessels. This phase-two clinical trial evaluates whether administration of an echocontrast agent in such ultrasound-refractory patients enhances image acquisition enough to yield meaningful diagnostic impressions.. This is a phase-two clinical trial of safety and efficacy of the "galactose/palmitic acid-based microbubble preparation" Levovist injection (Berlex Laboratories). Thirty subjects with clinical indications for cerebrovascular imaging but refractory to transcranial Doppler studies were enrolled in a nonrandomized, single-center study. Echocontrast agent was administered intravenously in a tiered-dose protocol. Safety was determined by clinical and laboratory monitoring for 18 to 24 hours. Efficacy of contrast enhancement was determined by comparisons between each patient's precontrast (control) and postcontrast images.. No significant patient discomfort, side effects, or adverse reactions occurred that were due to the intravenous administration of the echocontrast agent. Optimal image enhancement was obtained using the 300-mg/mL concentration (3 g bolus) of contrast. Visualization of both individual arterial segments and/or the entire circle of Willis was demonstrated. Clinical confidence of diagnostic impressions was achieved in 77% (23/30) of subjects.. The transpulmonary ultrasound contrast agent (Levovist injection) was easily administered and found to be safe in the 30 patients studied and increased the diagnostic utility of transcranial ultrasound in 77% of the patients studied.

Topics: Adult; Aged; Aged, 80 and over; Carotid Arteries; Cerebrovascular Disorders; Contrast Media; Female; Humans; Injections, Intravenous; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Transcranial; United States; Vascular Diseases

Fifty-one patients, with a range of underlying pathologic conditions, were studied prospectively to assess the diagnostic value of echo-enhanced color Doppler sonography in the pediatric and adolescent population Their diagnoses included various tumors, vascular disorders, cerebral bleeding, pathologic conditions of small parts, and focal lesions of parenchymal organs. All patients underwent color Doppler sonography before proceeding to echo-enhanced color Doppler sonography. Diagnoses were confirmed by additional imaging (computed tomography, magnetic resonance imaging, angiography, and scintigraphy) performed as appropriate, with or without histologic study. An additional 20 children did not proceed to echoenhanced color Doppler sonography as color Doppler sonography alone was found to be sufficiently diagnostic. Levovist (SHU 508A), a contrast agent based on galactose-encapsulated air microbubbles, is approved for pediatric applications in Austria and was used as the echo-enhancing agent. Echo-enhanced color Doppler sonography was performed a total of 63 times in 51 patients (mean age, 9.8 years). Compared to color Doppler sonography, echo-enhanced color Doppler sonography either detected or enhanced visualization of pathologic conditions in 55 investigations (87.3%), yielding an overall accuracy of 95.2% (sensitivity, 95%), versus 65.7% with color Doppler sonography. One spinal arteriovenous malformation, one cerebral cavernoma, and one liver lesion were missed. The contrast material was easy to administer; no adverse reactions were observed. We conclude that echoenhanced color Doppler sonography is beneficial in pediatric sonography. It enhances visualization of vessels and perfusion, thus offering a nonionizing imaging tool for detection and follow-up evaluation of pathologic conditions with disturbed vasculature in specific cases. In infants and in persons with superficial lesions it did not offer significant advantages over color Doppler sonography.

Topics: Adolescent; Adult; Age Factors; Arteriovenous Malformations; Child; Child, Preschool; Contrast Media; Female; Humans; Image Enhancement; Infant; Infant, Newborn; Kidney Diseases; Liver Diseases; Magnetic Resonance Imaging; Male; Neoplasms; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Tomography, Emission-Computed; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Urography; Vascular Diseases

Noninvasive pressure estimation in heart cavities and in major vessels would provide clinicians with a valuable tool for assessing patients with heart and vascular diseases. Some microbubble-based ultrasound contrast agents are particularly well suited for pressure measurements because their substantial compressibility enables microbubbles to vary significantly in size in response to changes in pressure. Pressure changes should then affect reflectivity of microbubbles after intravenous injection of a contrast agent. This has been demonstrated with a galactose-based contrast agent using 2.0-MHz ultrasound tone bursts. Preliminary results indicate that, over the pressure range of 0-186 mmHg, the subharmonic amplitude of scattered signals decreases by as much as 10 dB under optimal acoustic settings and the first and second harmonic amplitudes decrease by less than 3 dB. An excellent correlation between the subharmonic amplitude and the hydrostatic pressure suggests that the subharmonic signal may be utilized for noninvasive detection of pressure changes.

Topics: Contrast Media; Heart Diseases; Humans; Hydrostatic Pressure; Polysaccharides; Pressure; Ultrasonography; Vascular Diseases

Whereas conventional vascular surgical procedures are routinely monitored by ultrasound imaging, endovascular prostheses are usually monitored by radiographical imaging techniques. The aim of this study was to determine the safety, patient acceptance and role of ultrasound echo-enhancers (SHU 508 A) in the evaluation of endovascular devices. Nine patients were studied: six had stents (four in the internal carotid artery and two in the renal artery) and three had endoluminal prostheses (one in the abdominal aorta, one in the subclavian and one in the iliac artery). Endovascular patency and correct placement were studied with contrast angiography and ultrasound examination with and without contrast enhancement. Patients underwent angiography at the end of the endovascular procedure, and ultrasound examinations on the first postoperative day. Ultrasound contrast media (SHU 508 A) was injected through an antecubital vein at a rate of 1 ml/s. A total of 13 injections were given in nine patients. Ultrasonograms were obtained with 7.5 and 3.5 MHz transducers (Acuson 128 XP) and recorded on videotape for off-line visual inspection. Baseline and echo-enhanced sequences were assessed by two independent observers. None of the patients reported side-effects during or after the injection of the ultrasound echo-enhancer. Postoperative angiography showed endovascular patency and correct placement in all patients. The baseline ultrasound examination confirmed endoprosthesis patency in seven of nine patients: none revealed endoprosthesis malplacement. Contrast-enhanced ultrasound examination confirmed endoprosthesis patency. In two cases, the echo-contrast examination revealed persisting flow within the aneurysmal sac: in another patient it showed the incomplete adhesion of the distal portion of the endoprosthesis to the arterial wall. The preliminary findings suggest that ultrasound echo-enhancers are safe to use and induce no side-effects. Echo-enhanced sequences often provide additional information on the technical success of endovascular procedures. They promise to be useful in follow-up studies for assessing the functioning of endoprostheses.

Topics: Aged; Blood Vessel Prosthesis; Contrast Media; Female; Humans; Image Enhancement; Male; Middle Aged; Polysaccharides; Postoperative Period; Stents; Ultrasonography, Doppler, Pulsed; Ultrasonography, Interventional; Vascular Diseases