Diagnostic and Prognostic Value of Contrast-Enhanced Ultrasound in Acute Stroke

Zusammenfassung

Im letzten Jahrzehnt wurde in neurovaskulären Abteilungen die transkranielle farbkodierte Duplexsonografie (TCCS) als Routine in der Beurteilung der hirnversorgenden Arterien bei zerebrovaskulären Erkrankungen etabliert. Die TCCS hat sich als unkompliziert und zuverlässig, insbesondere zur Darstellung der A. cerebri media, erwiesen. Ein insuffizientes Knochenfenster kann die diagnostische Aussagekraft einschränken. Die Anwendung von Echokontrastverstärkern kann diese Limitation bei den meisten Patienten überwinden. Neben der Darstellung von Verschlussprozessen bietet die TCCS auch prognostische Information. Bei einem proximalen Verschluss der A. cerebri media, innerhalb von 6 Stunden mittels TCCS bei akutem Schlaganfall dargestellt, zeigt sich in fast 90% ein ungünstiges klinisches Ergebnis. Außerdem ist die TCCS zum Monitoring der Thrombolyse bei akutem Schlaganfall geeignet um eine Rekanalisation des betroffenen Gefäßes zu erkennen. Die Möglichkeit zur Untersuchung am Bett, die Nichtinvasivität und die Wirtschaftlichkeit machen die TCCS zu einer optimalen Methode für die Beurteilung der Hirnarterien bei akutem ischämischem Schlaganfall.

Abstract

In the last decade transcranial color-coded sonography (TCCS) was established as a routine in neurovascular departments for the evaluation of brain-supplying vessels in cerebrovascular diseases. TCCS has demonstrated feasibility and validity for the evaluation of the basal cerebral arteries, especially for the middle cerebral artery (MCA). In some patients an insufficient bone window may limit the diagnostic power. The application of microbubble agents can overcome this limitation in most patients. Beside the demonstration of vessel pathology such as stenosis and occlusion, TCCS also provides prognostic information. In the case of proximal MCA occlusion shown by TCCS within 6 hours of stroke, nearly 90 % of the patients suffered an unfavorable outcome. Furthermore TCCS is suitable for monitoring thrombolysis in acute stroke to detect whether there is recanalization of the affected vessel. The possibility for bedside examination, the non-invasiveness and the cost-effectiveness are features which make TCCS an optimal tool for the evaluation of cerebral vessels in acute ischemic stroke.

Key words

neurosonology - acute stroke - prognosis - contrast-enhanced transcranial sonography

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