卵圆孔未闭的检测。经食管超声心动图和经颅多普勒超声联合超声造影剂是“互补而非相互竞争的诊断方法”

[Detection of patent foramen ovale. Transesophageal echocardiography and transcranial Doppler sonography with ultrasound contrast media are "supplementary, not competing, diagnostic methods"].

作者信息

Heckmann J G, Niedermeier W, Brandt-Pohlmann M, Hilz M J, Hecht M, Neundörfer B

机构信息

Neurologische Klinik, Universität Erlangen-Nürnberg.

出版信息

Med Klin (Munich). 1999 Jul 15;94(7):367-70. doi: 10.1007/BF03044900.

DOI:10.1007/BF03044900

PMID:10437366

Abstract

BACKGROUND

The prevalence of patent foramen ovale (PFO) in healthy individuals is estimated to be about 25% and is elevated to 40% patients with stroke. To date transesophageal echocardiography (TEE) was considered to be the most sensitive method to detect PFO and was regarded as the gold standard. Transcranial Doppler sonography of the middle cerebral artery during contrast injection (c-TCD) has recently been proposed as an alternative method for the detection of PFO. We report our experience on 45 patients (age < 55 years) with stroke or transient ischemic attack (TIA) in whom both c-TCD and TEE were performed to detect PFO as a mechanism for embolic cerebral ischemia.

PATIENTS AND METHODS

In 45 patients (21 women, 24 men, mean age 41.4 years ranging from 17 to 54 years) with cerebral ischemia, both standardized TEE and standardized c-TCD were performed separately. When any PFO was found by TEE and/or c-TCD, it was classified as positive. If c-TCD was positive but TEE negative, a second TEE was performed and vice versa.

RESULTS

PFO was found epicritically in 26 patients (57.8%). First TEE detected PFO in 24 cases (sensitivity 92.3%). Separately performed c-TCD detected PFO in 22 cases of the PFO-positive cases (sensitivity 84.6%). However, c-TCD detected PFO in 2 cases, in which the first TEE had been negative, leading to a second TEE which confirmed PFO and demonstrated minimal shunt (7.7%). TEE detected PFO in 4 cases in which first c-TCD was negative. A second c-TCD confirmed in 2 of these 4 cases a positive right-to-left shunt. Neither method revealed false positive results (specifity 100%). The positive predictive value was 100% in both methods. The negative predictive value in TEE was 90.5% and in c-TCD was 82.6%.

CONCLUSION

TEE and c-TCD are not concurrent diagnostic tools to detect PFO. Both supplement each other. If both methods are used in all PFO-suspected patients, PFO detection rate is higher than when using either method alone.

摘要

背景

据估计，健康个体中卵圆孔未闭（PFO）的发生率约为25%，而在中风患者中这一比例则升至40%。迄今为止，经食管超声心动图（TEE）被认为是检测PFO最敏感的方法，并被视为金标准。最近，在注射造影剂期间对大脑中动脉进行经颅多普勒超声检查（c-TCD）被提议作为检测PFO的另一种方法。我们报告了45例年龄小于55岁的中风或短暂性脑缺血发作（TIA）患者的经验，对这些患者同时进行了c-TCD和TEE检查，以检测PFO作为栓塞性脑缺血的一种机制。

患者与方法

对45例脑缺血患者（21例女性，24例男性，平均年龄41.4岁，范围为17至54岁）分别进行了标准化的TEE和标准化的c-TCD检查。当TEE和/或c-TCD发现任何PFO时，将其分类为阳性。如果c-TCD为阳性但TEE为阴性，则进行第二次TEE检查，反之亦然。

结果

26例患者（57.8%）被确诊存在PFO。首次TEE检测到24例PFO（敏感性92.3%）。单独进行的c-TCD在22例PFO阳性病例中检测到PFO（敏感性84.6%）。然而，c-TCD在2例首次TEE为阴性的病例中检测到PFO，随后的第二次TEE证实了PFO并显示存在微量分流（7.7%）。TEE在4例首次c-TCD为阴性的病例中检测到PFO。在这4例中的2例中，第二次c-TCD证实存在从右向左的阳性分流。两种方法均未出现假阳性结果（特异性100%）。两种方法的阳性预测值均为100%。TEE的阴性预测值为90.5%，c-TCD的阴性预测值为82.6%。