Clinical significance of echocontrast enhancement in neurosonology: Aim of the study

To evaluate the potential and limitations of echocontrast enhancement using Levovist(R) in a non selected consecutive cohort of neurological patients with insufficient native ultrasound investigations. Methods: In 91 patients an indication for echocontrast application was seen after an insufficient extracranial (n =17), transtemporal (n = 54), and transforaminal (n = 20) Doppler- und color-coded Duplex sonography. Levovist(R) was injected at a concentration of 400 mg/ml and 200-400 mg/ml for the transcranial and extracranial approach, respectively. The effect of the echocontrast enhancement was assessed semiquantitatively with respect to signal enhancement, imaging quality, and diagnostic confidence. Results: In a total of 83 patients (91%) the signal enhancement led to a moderate to high imaging quality allowing to reach 67 definite neurovascular diagnoses (74%). In subgroup analysis, the amount of sufficiently confident examinations was significantly higher for the transtemporal and transforaminal (both 80%) than for the extracranial approach (47%). The latter was mostly due to artificial signals derived from adjacent neck vessels. Conclusion: Levovist(R) constitutes a safe and highly effective diagnostic tool especially for the transtemporal and transforaminal neurosonographical imaging. By means of a differentiated application of echocontrast agents, its cost-effectiveness can be increased and the need for other potential invasive and expansive neuroimaging methods can be further reduced.