Detection of cardiac right-to-left shunts by contrast-enhanced harmonic carotid duplex sonography.

Details

Serval ID
serval:BIB_2498011BD0BF
Type
Article: article from journal or magazin.
Collection
Publications
Title
Detection of cardiac right-to-left shunts by contrast-enhanced harmonic carotid duplex sonography.
Journal
Journal of Ultrasound in Medicine
Author(s)
Draganski B., Blersch W., Holmer S., Koch H., May A., Bogdahn U., Hölscher T., Schlachetzki F.
ISSN
0278-4297 (Print)
ISSN-L
0278-4297
Publication state
Published
Issued date
2005
Volume
24
Number
8
Pages
1071-1076
Language
english
Notes
Publication types: Journal Article
Abstract
OBJECTIVE: Paradoxical embolization by cardiac right-to-left shunts (RLS) is increasingly recognized as an important factor for embolic stroke. Contrast-enhanced transcranial Doppler sonography (ce-TCDS) is an established diagnostic tool for RLS detection but is frequently limited because of an inadequate temporal acoustic bone window. The purpose of this study was to determine whether extracranial sonography (ECS) using harmonic frequencies improves detection of RLS.
METHODS: Extracranial color duplex sonography using harmonic frequencies enables visualization of even single ultrasound contrast agent microbubbles because of oscillation. Patients with stroke and positive RLS findings on transesophageal echocardiography underwent a simultaneous extracranial and transcranial sonographic examination of the proximal common carotid artery (CCA) and middle cerebral artery (MCA) on the same side. A Valsalva strain was performed for 10 seconds after intravenous bolus injection of a galactose-based nontranspulmonary contrast agent. The B-mode frame sequences of the transverse plane of the CCA obtained by harmonic ECS and the ce-TCDS recordings of high-intensity transient signals from the MCA were analyzed offline.
RESULTS: In all patients with RLS, the shunts could be identified by harmonic ECS. A close correlation could be seen between the count of visualized microbubbles in the CCA and the number of high-intensity transient signals detected on ce-TCDS in the ipsilateral MCA.
CONCLUSIONS: The results of this study indicate that contrast-enhanced ultrasound harmonic imaging of the CCA using a Valsalva strain might be an optional screening tool for detection of cardiac RLS in patients with insufficient acoustic bone windows.
Keywords
Carotid Artery, Internal/ultrasonography, Contrast Media, Echocardiography, Transesophageal, Embolism, Paradoxical/etiology, Embolism, Paradoxical/ultrasonography, Feasibility Studies, Heart Septal Defects, Atrial/complications, Heart Septal Defects, Atrial/ultrasonography, Humans, Intracranial Embolism and Thrombosis/etiology, Intracranial Embolism and Thrombosis/ultrasonography, Male, Microbubbles, Middle Aged, Polysaccharides/diagnostic use, Statistics, Nonparametric, Ultrasonography, Doppler, Color, Ultrasonography, Doppler, Transcranial
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18/01/2013 17:56
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20/08/2019 13:02
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