Localization and characterization of intracerebral cavernous angiomas by intra-operative high-resolution colour-duplex-sonography.

The aim of this prospective study was to evaluate the reliability of high-resolution Colour-Duplex-Sonography (= CDS) in intra-operative localization, guiding and characterization of intracerebral cavernous angiomas (= CA). During a time period from 5/93 to 12/96 a total of 26 patients with 21 supratentorial and 5 infratentorial CA (15 of them deep-seated) were examined intra-operatively by CDS. The study focussed on 1. sonographic characterization, 2. localization in relationship to anatomical landmarks, 3. navigation, 4. correlation of sonographic to magnetic resonance imaging (= MRI), intra-arterial angiography (= DSA) and histological results and 5. control of complete resection. All CA appeared sonographically as hyperechoic lesions without flow-signals in Colour-mode. Imaging of anatomical landmarks as cerebral sulci, brain stem, insular cistern, falx, ventricles and vessels could be used for precise localization and successful guiding to 15 deep-seated lesions. The correlation of the size between MRI and CDS was excellent (1.4 mm mean difference, range from 0 to 5 mm). All 4 associated venous anomalies, as verified by pre-operative DSA, could be visualized and identified by CDS. The completeness of exstirpation was controlled sonographically in 14 cases and confirmed by MRI (= 10) and CT (= 4). This study provides the first comprehensive intra-operative characterization of CAs by CDS and correlation to MRI and DSA. Furthermore it demonstrates the reliability of CDS for intra-operative localization and guiding as well as its potential to control the complete exstirpation.

Lesion pattern in patients with multiple sclerosis and depression.

To assess if a specific lesion pattern or changes of the basal limbic system as seen in primary depression and depression associated with neurodegenerative disorders might be identified in depressive multiple sclerosis (MS) patients, we submitted 78 MS patients to a MRI examination consisting of a quantitative measurement of lesions and of hyperintense signals from the pontomesencephalic midline (raphe). Furthermore relaxometry of the pontomesencephalic midline, a transcranial ultrasound examination rating its echogenicity semiquantitatively and a standardized neurological, neuropsychiatric and neuropsychological assessment were obtained. Thirty-one patients fulfilled the DSM-IV criteria for depression. Depressed MS patients had a significantly larger temporal lesion load than non-depressed MS patients, especially on the right side. A trend of difference was detected for lesions of the right parietal lobe, the right frontal lobe, the cerebellum and the total lesion load. Neither hyperintense signals or relaxometry nor echogenicity of the region at the level of the pontomesencephalic midline were significantly different between the groups. We conclude that depression in MS patients is not associated with an alteration of the basal limbic system at the brainstem as seen in Parkinson's disease or unipolar depression but with an increased lesion load of the projection areas of the basal limbic system.

Diagnostic impact of cerebral transit time in the identification of microangiopathy in dementia: A transcranial ultrasound study.

BACKGROUND AND PURPOSE: The diagnosis and quantification of microangiopathy in dementia is difficult. The assessment of small-vessel disease requires expensive and sophisticated nuclear medicine techniques. This study was performed to identify microangiopathy related to the integrity of cerebral microcirculation by sonographic measurements (arteriovenous cerebral transit time [cTT]). METHODS: We performed transcranial color-coded duplex sonography in 40 patients with vascular dementia, 20 patients with Alzheimer's disease or Lewy body disease, and 25 age-matched controls. The clinical diagnosis was established by history of dementia and neuroimaging findings. Cognitive impairment was assessed by the Mini-Mental State Examination and Alzheimer's Disease Assessment Scale. cTT is defined as the time required by an ultrasound contrast agent to pass from a cerebral artery to a vein. This was measured by recording the power-Doppler intensity curves in the P2 segment of the posterior cerebral artery and the vein of Galen. Previous studies have shown a prolongation of cTT in patients with cerebral microangiopathy. RESULTS: cTT was substantially prolonged in patients with vascular dementia (5.8 seconds; 25th percentile 4.5; 75th percentile 7.5; U test, P<0.001) compared with controls (3.1 seconds; 2.3; 3.4) but not in patients with degenerative dementia (3.7 seconds; 3.7; 4.2). In patients with vascular dementia, cTT was significantly correlated with cognitive impairment. CONCLUSIONS: cTT may be useful tool to disclose small-vessel disease in demented patients. Examination is noninvasive and quickly performed. It may be also useful in follow-up examinations in patients undergoing therapy.