Transcranial Color‐Coded Real‐Time Sonography of Intracranial Veins

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Abstract
Sonographic findings in patients with superior sagittal sinus thrombosis were compared to those in healthy adults. Two patients with angiographically venf1ed superior sagittal sinus thrombosis were exam1ned by transcranial color‐coded real‐time sonography (TCCS) after mtravenous application of a pulmonary stable ultrasound contrast agent For comparison, 10 patients without venous pathology had contrast‐enhanced TCCS; in addition, 30 healthy adults had plain TCCS to determme the identification rate for deep and superficial venous segments and to define normal values of venous blood flow velocities. The straight sinus was identified in 22 of 30 healthy subjects by plain TCCS, and in 9 of 10 pat1ents by contrast‐enhanced TCCS. The mean peak and angle‐corrected blood flow velocity was 19.1 ± 7.1 em/sec. The super1or and inferior sagittal sinuses were identified by contrast‐enhanced TCCS in 2 and 1 subjects, respectively; they were never seen on pla1n TCCS. In the 2 patients with sagittal smus thrombosis a distinct increase of blood flow velocity was recorded from the stra1ght sinus (83 and 92 em/sec), most likely reflecting collateral circulation. These preliminary data mdicate that TCCS and particularly contrast‐enhanced TCCS permit identification and blood flow measurements within the deep and occasionally, the superficial venous system. TCCS may contribute to an assessment of hemodynamic repercussions of venous thrombosis and may indicate the risk of venous infarction and hemorrhage.