Hamilton-Craig C, Sestito A, Natale L, Meduri A, Santangeli P, Infusino F, Pilato F, Di Lazzaro V, Crea F, Lanza G A
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Eur J Echocardiogr. 2011 Mar;12(3):222-7. doi: 10.1093/ejechocard/jeq177. Epub 2010 Dec 29.
In 30-40% of patients with acute ischaemic stroke, the cause remains undefined (cryptogenic stroke). Contrast transoesophageal echocardiography (TEE) is considered the gold standard for patent foramen ovale (PFO) detection. Recently, however, cardiac magnetic resonance (CMR) has also been applied to detect PFO. In this study, we compared the diagnostic value of CMR and TEE in detecting PFO in a group of patients with apparently cryptogenic stroke.
Twenty-five patients (age 50 ± 13 years, 16 males) with apparently cryptogenic ischaemic stroke underwent contrast-enhanced TEE and contrast CMR for detection of possible PFO. Both imaging studies were performed during Valsalva manoeuvre. PFO grading results were assessed visually both for TEE and for CMR, according to the entity of contrast passage in the left atrium (grade 0 = no PFO; grades 1, 2, and 3 = mild, medium, and wide PFO, respectively). TEE detected PFO in 16 patients (64%). Contrast-enhanced CMR identified a PFO in 7 (44%) of these patients. TEE showed a grade 1 PFO in five patients, a grade 2 PFO in eight patients, and a grade 3 PFO in three patients. Of these patients, CMR failed to identify PFO in all five patients with a grade 1 PFO, in one patient with a grade 2 PFO, and one patient with grade 3 PFO according to TEE. None of the nine patients without PFO at TEE was shown to have a PFO at CMR. When compared with TEE, the present methodology of CMR had a sensitivity of 50%, specificity of 100%, negative predictive value of 31%, and a positive predictive value of 100%.
Our data suggest that TEE is the cornerstone imaging diagnostic test to detect and characterize PFO in patients with ischaemic stroke, and is shown to be better compared with the current CMR sequences.
在30% - 40%的急性缺血性卒中患者中,病因仍不明确(隐源性卒中)。对比经食管超声心动图(TEE)被认为是检测卵圆孔未闭(PFO)的金标准。然而,最近心脏磁共振成像(CMR)也被用于检测PFO。在本研究中,我们比较了CMR和TEE在一组疑似隐源性卒中患者中检测PFO的诊断价值。
25例(年龄50±13岁,男性16例)疑似隐源性缺血性卒中患者接受了对比增强TEE和对比CMR检查,以检测可能存在的PFO。两项影像学检查均在瓦尔萨尔瓦动作期间进行。根据左心房内对比剂通过情况对TEE和CMR的PFO分级结果进行视觉评估(0级 = 无PFO;1级、2级和3级分别为轻度、中度和重度PFO)。TEE在16例患者(64%)中检测到PFO。对比增强CMR在其中7例(44%)患者中发现了PFO。TEE显示5例患者为1级PFO,8例患者为2级PFO,3例患者为3级PFO。在这些患者中,根据TEE结果,CMR未能在所有5例1级PFO患者、1例2级PFO患者和1例3级PFO患者中识别出PFO。TEE检查无PFO的9例患者中,CMR检查均未显示存在PFO。与TEE相比,目前CMR的方法敏感性为50%,特异性为100%,阴性预测值为31%,阳性预测值为100%。
我们的数据表明,TEE是检测和评估缺血性卒中患者PFO的影像学诊断基石,与目前的CMR序列相比表现更优。