Background and Purpose: Visualization of normal or pathological flow in the intracranial arteries using transcranial colour-coded duplex sonography (TCCS) is occasionally obstructed by insufficient temporal bone windows, unfavourable insonation angles, or low flow velocities or volumes. SonoVue® (BR1) is a new, long-acting echocontrast agent, which could be helpful in these instances. Methods: SonoVue was studied in two separate multicentre investigations of patients with insufficient bone windows (BR1-014 with 73 patients and BR1-017 with 40 patients) using an identical protocol. The agent was given intravenously as a bolus in four different doses (0.3, 0.6, 1.2 and 2.4 ml). Evaluation was performed on-site and off-site with video clips. Results: The contrast agent was well tolerated. As compared to the precontrast scans, SonoVue facilitated the visualization of vessel patency, stenosis, occlusion, and collateral flow, decreased the need for additional tests, and had an impact on the patient’s treatment. In 66–74%, a non-diagnostic investigation was converted into a diagnostic investigation. The highest dose (2.4 ml) allowed for a clinically useful signal enhancement of a median 1.9–6.3 min. Conclusions: SonoVue at a single dose of 1.2 or 2.4 ml is effective in increasing the detection of normal or pathological flow in the intracerebral arteries in patients who do not have a fully diagnostic unenhanced TCCS examination.

Keywords:
Ultrasonography, Duplex scanning, Contrast media, SonoVue®
1.
Baumgartner RW, Mathis J, Sturzenegger M, Mattle HP: A validation study on the intraobserver reproducibility of transcranial color-coded duplex sonography velocity measurements. Ultrasound Med Biol 1994;20:233–237.
2.
Bogdahn U, Becker G, Winkler J, Greiner K, Perez J, Meurers B: Transcranial color-coded real-time sonography in adults. Stroke 1990;21:1680–1688.
3.
Goertler M, Kross R, Baeumer M, Jost S, Grote R, Weber S, Wallesch CW: Diagnostic impact and prognostic relevance of early contrast-enhanced transcranial color-coded duplex sonography in acute stroke. Stroke 1998;29:955–962.
4.
Kaps M, Seidel G, Bauer T, Behrmann B: Imaging of the intracranial vertebrobasilar system using color-coded ultrasound. Stroke 1992;23:1577–1582.
5.
Nabavi DG, Droste DW, Schulte Altedorneburg G, Kemeny V, Panzica M, Weber S, Ringelstein EB: Diagnostic benefit of echocontrast enhancement for the insufficient transtemporal bone window. J Neuroimaging 1999;9:102–107.
6.
Baumgartner RW, Arnold M, Gonner F, Staikow I, Herrmann C, Rivoir A, Muri RM: Contrast-enhanced transcranial color-coded duplex sonography in ischemic cerebrovascular disease. Stroke 1997;28:2473–2478.
7.
Baumgartner RW, Mattle HP, Aaslid R, Kaps M: Transcranial color-coded duplex sonography in arterial cerebrovascular disease. Cerebrovasc Dis 1997;7:57–63.
8.
Droste DW, Jürgens R, Weber S, Tietje R, Ringelstein EB: Benefit of echocontrast-enhanced transcranial color-coded duplex ultrasound in the assessment of intracranial collateral pathways. Stroke 2000;31:920–923.
9.
Droste DW, Kaps M, Nabavi DG, Ringelstein EB: Ultrasound contrast enhancing agents in neurosonology: Principles, methods, future possibilities. Acta Neurol Scand 2000;102:1–10.
10.
Droste DW, Nabavi DG, Kemény V, Schulte-Altedorneburg G, Ritter M, Weber S, Ringelstein EB: Echocontrast enhanced transcranial color-coded duplex offers improved visualization of the vertebrobasilar system in patients with bad examination conditions. Acta Neurol Scand 1998;98:193–199.
11.
Kaps M, Seidel G, Bokor D, Modrau B, Algermissen C: Safety and ultrasound-enhancing potentials of a new sulfur hexafluoride-containing agent in the cerebral circulation. J Neuroimaging 1999;9:150–154.
12.
Schneider M, Arditi M, Barrau MB, Brochot J, Broillet A, Ventrone R, Yan F: BR1: A new ultrasonographic contrast agent based on sulfur hexafluoride-filled microbubbles. Invest Radiol 1995;30:451–457.
13.
Hankey GJ, Warlow C, Sellar RJ: Cerebral angiographic risk in mild cerebrovascular disease. Stroke 1990;21:209–222.
14.
Young B, Moore WS, Robertson JT, Toole JF, Ernst CB, Cohen SN, Broderick JP, Dempsey RJ, Hosking JD, for the ACAS Investigators: An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. Stroke 1996;27:2216–2224.
15.
Nabavi DG, Droste DW, Kemény V, Schulte-Altedorneburg G, Weber S, Ringelstein EB: Potential and limitations of echocontrast-enhanced ultrasonography in acute stroke patients: A pilot study. Stroke 1998;29:949–954.
16.
Kaps M, Link A: Transcranial ultrasound monitoring during thrombolytic therapy. Am J Neuroradiol 1997;19:758–760.
17.
Ringelstein EB, Weiller C, Weckesser M, Weckesser S: Cerebral vasomotor reactivity is significantly reduced in low-flow as compared to thromboembolic infarctions: The key role of the circle of Willis. J Neurol Sci 1994;121:103–109.
18.
Doblar DD, Plyushcheva NV, Jordan W, McDowell H: Predicting the effect of carotid artery occlusion during carotid endarterectomy: Comparing transcranial Doppler measurements and cerebral angiography. Stroke 1998;29:2038–2042.
19.
Lopez Bresnahan MV, Kearse LA Jr, Yanez P, Young TI: Anterior communicating artery collateral flow protection against ischemic change during carotid endarterectomy. J Neurosurg 1993;79:379–382.
20.
Schneider PA, Ringelstein EB, Rossman ME, Dilley RB, Sobel DF, Otis SM, Bernstein EF: Importance of cerebral collateral pathways during carotid endarterectomy. Stroke 1988;19:1328–1334.
21.
Schneider PA, Rossman ME, Bernstein EF, Torem S, Ringelstein EB, Otis SM: Effect of internal carotid artery occlusion on intracranial hemodynamics. Transcranial Doppler evaluation and clinical correlation. Stroke 1988;19:589–593.
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2002
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