Contrast-Enhanced Transcranial Color-Coded Duplexsonography in Stroke Patients with Limited Bone Windows
Georg Gahn
,a,
Johannes Gerbera,
Susanne Hallmeyera,
Gabriele Hahna,
Robert H. Ackermana,
Heinz Reichmanna and
Rüdiger von Kummera
a From the Departments of Neurology (G.G., S.H., G.H., H.R.) and Neuroradiology (J.G., R.v.K.), University of Technology, Dresden, Germany, and the Neurovascular Laboratory (RHA), Radiology Department and Neurology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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FIG 1. A and B, Unenhanced TCCD (A) provides no detectable colorflow signals; contrast-enhanced TCCD (B) of same patient shows the complete circle of Willis
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FIG 2. A–C, TCCD without contrast enhancement (A) of a 57-year-old man provides no colorflow signals; contrast-enhanced TCCD (B) shows a mild left middle cerebral artery stenosis (arrow); Correlative CTA (C) confirms mild middle cerebral artery stenosis (arrow).
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FIG 3. A and B, Unenhanced TCCD (A) of a 78-year-old woman provides no colorflow signals; contrast-enhanced TCCD (B) shows entire circle of Willis except for left MCA (yellow arrow), indicating MCA occlcusion.
C, Correlative CTA confirms MCA occlusion (white arrow). Left A1 appears hypoplastic, yet contrast-enhanced TCCD makes both A1 segments appear similar in size, a possible blooming effect. Left M1 segment appears shorter on contrast-enhanced TCCD image than on CTA (arrowheads). Because 2 hours elapsed between the performance of contrast-enhanced TCCD and CTA, this may represent partial recanalization of the MCA.
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