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We tried to evaluate the usefulness of the transcranial color flow imaging (TCFI) as a noninvasive imaging method for Intracranial space occupied lesion (I-SOL) .METHOD-TCFI (ATL, ULTRAMARK 9® 2.25 MHz phazed arrey, 90° sector scan) was applied from the.. bitemporal “acoustic window” to 22 meningiomas, 12 pituitary adenomas, 5 gliomas, I intraventricular tumor, 4 arteriovenous malformations (AVM), 7 intracerebral hematomas (ICH), 8 chronic subdural hematomas (CSH), 2 acute epidural hematomas (AEH), and 1 pediatric arachnoid cyst. RESULT-We were able to detect 12 meningiomas, 7 adenomas, 1 cystic glioma, 1 ventricular tumor, 2 AVMs, 6 ICHs, 6 CSHs, 2 AEHs, and 1 arachnoid cyst, as clearly defined lesions on B-mode images.It was difficult to visualize the region of the posterior fossa. Frontal and high convexity regions were also difficult to investigate. CONCLUSION-TCFI has great advantages : movability, noninvasiveness and blood flow detection factors. It provides an useful diagnostic method for the I-SOL.

The measurement of cerebrovascular CO2 reactivity is very important to assess the pathophysiology of cerebrovascular disease. However, the conventional methods for measurement of CO2 reactivity are invasive and need radioisotope or other tracers. Transcranial Doppler (TCD) is a new method to evaluate the mean flow velocity of the middle cerebral artery (MCA) non-invasively. Cerebral blood flow (CBF) and MCA flow velocity have been measured simultaneously using laser Doppler and TCD, respectively in our department. This study showed changes of CBF measured by laser Doppler and velocity measured by TCD relatively. Therefore, the vasodilatory capacity to increase in PaCO2 can be tested by measurement of MCA flow velocity using TCD. The elevation of end-tidal PCO2 was achieved by re-breathing the alr expired air from a respiratory bag. The CO2 reactivity was easily calculated by a personal computer using en equation obtained from the mean flow velocoty and end-tidal PCO2 within a range of 3060 mmHg. We have studied the CO2 reactivity in patients suffering from rarious neurosurgical diseases. The reduction of CO2 reactivity was detected in patients with symptomatic vasospasm, normal pressure hydrocephalus, cerebral infarction, Moyamoya disease and chronic subdural hematoma.

It is generally believed that TCD is not helpful in detecting intracranial aneurysms smaller than 15mm in diameter, to despite great improvement in technology of transcranial Doppler (TCD) in transcranial Doppler angiography (TCDA), three dimentional transcranial Doppler (3D-TCD) and transcranial color flow image (TCFI) . So far there haven't been any reports to challenge this theory. In this study, we examined a 50-yearold female with diffuse subarachnoid hemorrhage. We were able to detect four aneurysms in this patient. The size of aneurysms ranged from 2mm to 9mm in diameter using TCFI under the following criteria before cerebral angiography. We conducted the experiment as follow:1) Set up sample volume from 1.5 × 1.0mm to 3.0 × 1.0mm.2) Carefully scanned the captured artery.3) Detected an appendage structure with pathological blood flow near the normal cerebral artery using axial and coronal view in B-mode scan.4) Detected a pathlogical color-flow image with Doppler sonogram, which indicates a turbulent flow.5) Found normal flow pattern at the proximal and distal portions of the turbulent flow region.This is the first report showing the turbulent flow of small cerebral aneurysms using B-mode scan and Doppler son ogram.We believe that our report indicates the reliability of TCFI for screening unruptured cerebral aneurysms.