Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.
Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece.
Ann Neurol. 2016 Apr;79(4):625-35. doi: 10.1002/ana.24609. Epub 2016 Mar 11.
Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic ischemic stroke or transient ischemic attack has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach.
We performed a systematic literature review to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD, or both compared to the gold standard of TEE.
Our literature search identified 35 eligible studies including 3,067 patients. The pooled sensitivity and specificity for TCD was 96.1% (95% confidence interval [CI] = 93.0-97.8%) and 92.4% (95% CI = 85.5-96.1%), whereas the respective measures for TTE were 45.1% (95% CI = 30.8-60.3%) and 99.6% (95% CI = 96.5-99.9%). TTE was superior in terms of higher positive likelihood ratio values (LR+ = 106.61, 95% CI = 15.09-753.30 for TTE vs LR+ = 12.62, 95% CI = 6.52-24.43 for TCD; p = 0.043), whereas TCD demonstrated lower negative likelihood values (LR- = 0.04, 95% CI = 0.02-0.08) compared to TTE (LR- = 0.55, 95% CI = 0.42-0.72; p < 0.001). Finally, the area under the summary receiver operating curve (AUC) was significantly greater (p < 0.001) in TCD (AUC = 0.98, 95% CI = 0.97-0.99) compared to TTE studies (AUC = 0.86, 95% CI = 0.82-0.89).
TCD is more sensitive but less specific compared to TTE for the detection of PFO in patients with cryptogenic cerebral ischemia. The overall diagnostic yield of TCD appears to outweigh that of TTE.
经食管超声心动图（TEE）检查，多达 43%的隐源性脑缺血患者可发现卵圆孔未闭（PFO）。经胸超声心动图（TTE）在检测隐源性缺血性卒中和短暂性脑缺血发作患者 PFO 中的诊断价值尚未通过综合荟萃分析与经颅多普勒（TCD）进行比较。
我们进行了系统的文献检索，以确定所有前瞻性观察性研究患者的研究，这些研究均提供了 TTE、TCD 或两者与 TEE 金标准相比的敏感性和特异性测量值。
我们的文献检索确定了 35 项符合条件的研究，包括 3067 名患者。TCD 的汇总敏感性和特异性分别为 96.1%（95%置信区间[CI] = 93.0-97.8%）和 92.4%（95%CI = 85.5-96.1%），而 TTE 的相应指标分别为 45.1%（95%CI = 30.8-60.3%）和 99.6%（95%CI = 96.5-99.9%）。TTE 的阳性似然比（LR+）值更高（TTE 的 LR+ = 106.61，95%CI = 15.09-753.30，TCD 的 LR+ = 12.62，95%CI = 6.52-24.43；p = 0.043），而 TCD 的阴性似然比（LR-）值（TTE 的 LR- = 0.04，95%CI = 0.02-0.08，TCD 的 LR- = 0.04，95%CI = 0.02-0.08；p < 0.001）低于 TTE。最后，汇总受试者工作特征曲线下面积（AUC）在 TCD 中明显更大（p < 0.001）（AUC = 0.98，95%CI = 0.97-0.99），而 TTE 研究（AUC = 0.86，95%CI = 0.82-0.89）。
与 TTE 相比，TCD 对隐源性脑缺血患者 PFO 的检测更敏感，但特异性较低。TCD 的总体诊断效果似乎优于 TTE。
