[Organic schizophreniform disorder with pre-existing autoimmune thyroiditis]. / Organische schizophreniforme Störung bei Autoimmunthyreopathie.

We report the case of a 63-year-old patient with sudden onset of an acute syndrome of auditory hallucinations and delusions. Considering the anamnesis, course of the illness, and organopathologic results, we assumed an organic schizophreniform disorder within the scope of pre-existing autoimmune thyroiditis. Under treatment with high-potency neuroleptics, we observed partial regression and, after strumectomy, complete regression of the psychotic symptoms. Apparently, the acute organic schizophreniform disorder was caused by a changed metabolic situation with a transition to hyperthyroidism coinciding with beginning a small dose of antithyroid drugs.

Harmonic imaging of the brain parenchyma using a perfluorobutane-containing ultrasound contrast agent.

We evaluated the signal-enhancing effect of the novel perfluorobutane-based ultrasound contrast agent BR 14 (Bracco Research, Switzerland) in grey-scale harmonic imaging of the brain parenchyma. Six sedated male beagle dogs were investigated with transcranial grey-scale harmonic imaging (SONOS 5500, 1.8/3.6 MHz). After bolus injection of two different doses of BR 14, acoustic densitometry was performed to quantify changes in regional contrast intensity. In the dogs' brain parenchyma, the mean relative peak increase in acoustic intensity was +61% after administration of 0.05 ml/kg BW of BR 14 and +24% after 0.2 ml/kg BW. In the masticatory muscle, application of the higher dose resulted in a stronger increase in contrast intensity compared to the lower dose. Evaluation of the contralateral base of the skull showed a dose-dependent decrease in acoustic intensity. Bolus injection of BR 14 produces an increase in acoustic intensity, which can be used for the visualization of contrast agent in the brain parenchyma. Using high dosages, a strong signal-enhancing effect in the regions near the ultrasound probe leads to a consecutive attenuation of signals from structures being located beyond ("shadowing-effect"). This is the explanation for the paradoxical result that the higher dose leads to a lower peak signal increase in the brain parenchyma.

Pharmacokinetics of echocontrast agent infusion in a dog model.

Ultrasound contrast agents (UCAs) have a distinct diagnostic impact on transcranial Doppler (TCD) and duplex sonography. In addition to the properties of the UCA and ultrasound imaging modes, the duration of contrast enhancement depends on the administration mode. Infusion of UCAs may be appropriate for prolonging the diagnostically useful time of elevated Doppler intensity. Five sedated dogs were investigated by TCD during infusion with SonoVue, a new UCA consisting of sulfur hexafluoride microbubbles. The infusion rate was varied, and the time-intensity curves were analyzed. Infusion rate of 70 ml/h provided a stable mean level of increased Doppler intensity up to 24 to 26 dB over baseline, whereas a rate of 35 ml/h did not result in a stable plateau (range 8-19 dB over baseline [5 minutes after starting time]). The maximum increases in Doppler mean intensity (18.2 dB [35 ml/h] and 25.6 dB [70 ml/h]) were significantly different (P = .025). Pharmacokinetic analysis of SonoVue during inflow (by exponential functional fitting of the time-mean intensity curves) and elimination (by linear regression analysis) revealed no dose-related differences. This study demonstrated a dose-dependent level of increased Doppler mean intensity within the brain circulation during infusion of SonoVue. Unlike the bell-shaped course of Doppler signal enhancement seen after bolus injection, infusion generates a stable plateau, which is an important prerequisite for more advanced contrast applications.

Quantification of flow rates using harmonic grey-scale imaging and an ultrasound contrast agent: an in vitro and in vivo study.

It is unclear if the dye-dilution theory and its corresponding parameters are capable of measuring brain perfusion using harmonic grey-scale imaging. We performed a study on a flow phantom using a SONOS 5500 (1.8--3.6-MHz harmonic imaging) and Levovist as the ultrasound (US) contrast agent (UCA). We applied the UCA in six different doses (0.1 to 3.0 mL) and used eight different flow-rates (180 to 540 mL/min). Additionally, we performed a study on dog brain using Levovist boluses of 1.5 mL and 3 mL. We evaluated the influence of dose and flow-rate on the parameters of the time-intensity curve: peak signal intensity (PSI), area under the curve (AUC) and mean transit time (MTT). Along with an increase of the Levovist dose, the AUC and the PSI increased only in the dose range between 0.1 and 0.5 mL Levovist; further increase led to no change of parameters. Flow-rate showed no influence on AUC, MTT or PSI. The dye-dilution theory is not a useful theoretical model for the analysis of perfusion using harmonic grey-scale imaging. A possible explanation for this effect is the bubble saturation.

Arteriovenous bubbles following cold water sport dives: relation to right-to-left shunting.

Neurologic injury subsequent to decompression from diving may be due to paradoxical arterialization of venous gas emboli. Of 40 divers who performed 53 open water dives after being tested for a patent foramen ovale (PFO), arterial gas emboli were detected in 7 of 13 dives, which resulted in venous bubbles. In five of these seven dives, there was evidence of a PFO by contrast transcranial Doppler sonography, indicating an increased risk of arterializing venous bubbles in divers with a PFO.

Visualization of brain perfusion with harmonic gray scale and power doppler technology : an animal pilot study.

BACKGROUND AND PURPOSE: It is unclear which harmonic imaging mode (power Doppler or gray-scale imaging) is superior and which measuring method is the most robust for the description of brain perfusion. METHODS: We performed an animal study on 6 beagles through the intact skull using a SONOS 5500 device and Optison injected intravenously in 3 different doses (0.15, 0.3, and 0.6 mL). Intensity versus heart-cycle plots for the brain parenchyma and the basal cerebral arteries were generated to evaluate the peak increase (PI) from baseline and the area under the curve (AUC). RESULTS: With harmonic gray-scale imaging, a homogeneous increase in echo contrast of the brain parenchyma was observed. The effect was dose dependent, resulting in a significant increase in PI as well as an insignificant increase of the AUC with 0.3 mL versus 0.15 mL contrast agent (P=0.03 and P=0.65, respectively; n=5). With harmonic power Doppler, injection of the 3 different doses resulted in a nonsignificant increase in PI and AUC P=0.17, n=6 for both). After normalization of the brain signal to the peak arterial signal in individual dogs, a significant increase could be demonstrated (P=0. 03 and P=0.01, respectively; n=6). The signal pattern of harmonic power Doppler was inhomogeneous, with stronger signal increases in the anterior part of the brain. CONCLUSIONS: Gray-scale imaging leads to a more homogeneous increase in echo contrast of the brain tissue and may be more suitable for displaying brain perfusion. The PI of the signal intensity seems the most robust parameter for the description of cerebral perfusion with both imaging modes under investigation.

Harmonic imaging of the human brain. Visualization of brain perfusion with ultrasound.

BACKGROUND AND PURPOSE: Through harmonic gray-scale imaging, it is possible to analyze brain tissue perfusion with different ultrasound methods. METHODS: In 12 healthy volunteers, 2 doses (0.5 and 1.5 mL) of Optison, a perfluoropropane-containing contrast agent, were injected intravenously and produced a strong increase of brightness in the brain parenchyma. We used harmonic imaging for quantification of ultrasound intensity in the thalamus, ipsilateral temporoparietal white matter (TPWM), and ipsilateral lateral fissure at both sides. Time-intensity curves were calculated, and peak increase (PI) of intensity and the area under the time-intensity curve (AUC) from baseline were compared. RESULTS: We found a significant dose dependence of the AUC in all regions at both sides. PI only showed a significant dose dependence in the TPWM but not in the ipsilateral thalamus and lateral fissure. No side differences for AUC and PI were detected in all regions and doses used. We found a significantly higher value of the PI insonating the thalamus from the ipsilateral side compared with the contralateral side. The same result was obtained for the AUC in the left thalamus for both doses and in the right thalamus for the high dose. Using 0.5 mL for insonation of the right thalamus AUC again showed a higher value for the insonation from the ipsilateral compared with the contralateral side but failed to show statistical significance (P=0.08, n=12). CONCLUSIONS: Harmonic gray-scale imaging with Optison showed a strong enhancement effect in the brain parenchyma. A quantitative analysis of perfusion seems difficult because of the depth dependence of the effect. The most robust parameter is the AUC.

Transcranial harmonic power duplex sonography for the evaluation of cerebral arteries.

Harmonic power-based duplex sonography is a new ultrasound method that improves the signal-to-noise ratio of extracranial vascular imaging. The authors evaluated this new method for transtemporal imaging of the basal cerebral arteries. Fundamental power-based duplex sonography (p-TCCS) and harmonic power-based duplex sonography (HI-p-TCCS) in combination with a novel perfluoropropane-containing ultrasound contrast agent (Optison) were investigated for the evaluation of the basal cerebral arteries in 12 healthy volunteers. The number of identified vascular segments and the blood flow velocities in the middle and posterior cerebral arteries were determined for p-TCCS and for two doses of Optison (0.5 and 1.5 mL) using HI-p-TCCS. Furthermore, the authors determined the time course of signal enhancement after Optison bolus injections. The results were compared using Friedman two-way ANOVA test. Significantly more arterial segments were visualized using HI-p-TCCS with enhancement of either 0.5 mL or 1.5 mL Optison (p < 0.01, each) than using p-TCCS. The spatial resolution was markedly increased with HI-p-TCCS, resulting in a striking difference in the detection of distal arterial segments and cortical and parenchymal branches. Except for the diastolic blood flow velocities (BFVs) in the M1 segment, the BFVs did not differ significantly between p-TCCS and HI-p-TCCS. Comparing HI-p-TCCS with 0.5 mL and 1.5 mL Optison, the authors found a small but significant reduction of the latency period (18.2 vs. 15.9 seconds, respectively; p < 0.01), a significant increase of the blooming phase (62.7 vs. 99.8 seconds, respectively; p < 0.0006) and a significant prolongation of the diagnostically useful signal enhancement (233.7 vs. 427.6 seconds, respectively; p < 0.004).

Safety and ultrasound-enhancing potentials of a new sulfur hexafluoride-containing agent in the cerebral circulation.

Insufficient ultrasound penetration through the temporal bone is a serious limitation of transcranial ultrasound diagnostics. In a phase I study, the authors studied safety and ultrasound enhancing potentials of the new transpulmonary ultrasound contrast agent SonoVue, which contains sulfur hexafluoride gas microbubbles stabilized by a phospholipid shell. Twelve healthy volunteers received four different doses of SonoVue (0.3 ml, 0.6 ml, 1.2 ml, and 2.4 ml) intravenously. The duration of ultrasound contrast enhancement was measured by transcranial Doppler sonography (TCD) and transcranial color-coded sonography (TCCS). Safety and tolerability was monitored during the study and for 24 hours after contrast agent administration. TCD: Duration of spectral enhancement (signal intensity of 5 dB over baseline) was observed dose-related (p < 0.0001; Friedman-test) for (0.3 ml) 136 +/- 63.4 seconds; (0.6 ml) 191 +/- 63.3 seconds; (1.2 ml) 314 +/- 88 seconds; (2.4 ml) 434 +/- 168 seconds [mean +/- SD]. Dependent on dosage, the peak signal amplification in TCD was significantly different (p < 0.001; Friedman-test) as well: (0.3 ml) 24.5 +/- 2.0 dB; (0.6 ml) 26.0 +/- 1.6 dB; (1.2 ml) 27.6 +/- 2.2 dB; (2.4 ml) 28.4 +/- 2.2 dB (mean +/- SD). TCCS: Mean time of optimal enhancement increased from 214 +/- 73 seconds (0.3 ml) to 356 +/- 14 seconds (2.4 ml) in a dose-dependent manner. In TCCS, signal amplification appeared to be stronger with increasing doses. Adverse events were not observed during the study. This investigation describes the ultrasound enhancing potential of SonoVue in the intracranial cerebral circulation. SonoVue proved to be well tolerated and provided a long-lasting ultrasound contrast enhancement that supports an optimal transcranial ultrasound diagnostic.

The influence of Doppler system settings on the clearance kinetics of different ultrasound contrast agents.

OBJECTIVE: To evaluate the influence of different Doppler system settings on time-intensity curves after ultrasound contrast agent (UCA) bolus injection. This is important for the comparison of different UCAs. METHODS: Six sedated dogs were investigated with a transcranial Doppler system and Doppler power, sample volume size and high pass filter settings were modified during the procedure. Mean time intensity curves were determined and peak values of mean intensity as well as the decrease in Doppler intensity were compared for the different system settings. Three different UCAs were used (SonoVue(TM), BY963 and Levovist(TM)). RESULTS: The Doppler time intensity curves showed a typical two phase decrease with a distribution phase alpha and an elimination phase beta with all three UCAs. Altering the system settings had a significant effect on the mean peak Doppler intensity for SonoVue(TM) (P=0.02) but not for BY963 or Levovist(TM) (P=0.07 and P=0.39, respectively), due to high variation of the Levovist(TM) and BY963 intensity values. There were no significant differences between the alpha slopes of BY963 and Levovist(TM) (P=0.96), or the beta slope of Levovist(TM) and SonoVue(TM) (P=0.62), when the results of all system settings were combined. CONCLUSION: Different Doppler system settings show no significant influence on the decrease of mean Doppler intensity, but have a significant effect on peak intensity.