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Echoenhancers and Transcranial Color Duplex Sonography

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    Echoenhancers and Transcranial Color Duplex Sonography. Edited by ulrich bogdahn, georg becker, and felix schlachetzki. (Pp 420). Published by Blackwell Science, Oxford 1998. ISBN 0-632-04856-5.

    Transcranial colour duplex sonography is an ultrasound technique which is becoming increasingly available for the non-invasive imaging of intracranial structures, particularly the basal cerebral arteries. There are now four principal components to the technique: B mode ultrasound which can be used to image the brain parenchyma; colour coded Doppler which provides a colour image of the basal vessels; spectral analysis of pulsed wave Doppler which is used to derive blood flow velocities; and latterly “power” Doppler which is also used for vascular imaging following analysis of the amplitude rather than the frequency of the reflected ultrasound beam. In addition, echocontrast agents are now available which can increase the signal to noise ratio and thus help overcome some of the detrimental acoustic effects of the skull.

    This volume of 400 pages and liberal colour diagrams and prints is edited by three exponents of the technique. Thirty one chapters written by a further 20 contributors cover topics from the history of transcranial ultrasound, through the physics of Doppler ultrasound to potential clinical applications. The book is helpfully split into two sections with the theoretical aspects described in the first half and clinical aspects in the second.

    This is certainly a specialised book and will really only appeal to those interested in, or wishing to develop, expertise in transcranial colour coded ultrasound. For such readers the technical chapters on instrumentation, signal processing, echocontrast agents, harmonic imaging etc will certainly provide a complete understanding of the priciples behind the technique. I think that some of the errors made in the interpretation of vascular ultrasound examinations are due to an incomplete understanding of the physics of Doppler ultrasound, hence the attention paid to this area is commendable.

    The clinical section covers the examination technique, normal reference values, the main categories of cerebrovascular disease, and also contains chapters on areas which may be less immediately suitable for ultrasound study. For example, the findings in head trauma, tumours, psychiatric disorders, and movement disorders are the subject of separate chapters. Although I have no problem with enthusiasm for this technique a little pragmatism would not go amiss. A more balanced discussion of the limitations as well as potentials of the technique could have been applied.

    As with any book with multiple authors there is some variation in style and overlap, particularly in the introductions and conclusions of the chapters. Nevertheless, it is a comprehensive current review of transcranial colour coded sonography. Although the reader must decide exactly how this technique fits into clinical practice the book will certainly stimulate some ideas.

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