Yao Qingyang, Xiong Huahua, Zhang Daxue, Ren Shuqun, Qi Wenwei, Zou Xia, Zhao Yingying, Huang Shanshan, Wang Jing, Cao Liming
Department of Neurology, The First Hospital of Quanzhou Affliated to Fujian Medical University, Quanzhou, Fujian, China.
Department of Ultrasound, Shenzhen Second People's Hospital, Shenzhen, China.
Front Neurol. 2023 Jun 20;14:1148846. doi: 10.3389/fneur.2023.1148846. eCollection 2023.
Right-to-left shunt (RLS) is associated with several conditions and causes morbidity. In this study, we aimed to evaluate the effectiveness of synchronous multimode ultrasonography in detecting RLS.
We prospectively enrolled 423 patients with high clinical suspicion of RLS and divided them into the contrast transcranial Doppler (cTCD) group and synchronous multimode ultrasound group, in which both cTCD and contrast transthoracic echocardiography (cTTE) were performed during the same process of contrast-enhanced ultrasound imaging. The simultaneous test results were compared with those of cTCD alone.
The positive rates of grade II (22.0%:10.0%) and III (12.7%:10.8%) shunts and the total positive rate (82.1748%) in the synchronous multimode ultrasound group were higher than those in the cTCD alone group. Among patients with RLS grade I in the synchronous multimode ultrasound group, 23 had RLS grade I in cTCD but grade 0 in synchronous cTTE, whereas four had grade I in cTCD but grade 0 in synchronous cTTE. Among patients with RLS grade II in the synchronous multimode ultrasound group, 28 had RLS grade I in cTCD but grade II in synchronous cTTE. Among patients with RLS grade III in the synchronous multimode ultrasound group, four had RLS grade I in cTCD but grade III in synchronous cTTE. Synchronous multimode ultrasound had a sensitivity of 87.5% and specificity of 60.6% in the patent foramen ovale (PFO) diagnosis. Binary logistic regression analyses showed that age (odds ratio [OR] = 1.041) and risk of paradoxical embolism score ≥ 7 (OR = 7.798) were risk factors for stroke recurrence, whereas antiplatelets (OR = 0.590) and PFO closure with antiplatelets (OR = 0.109) were protective factors.
Synchronous multimodal ultrasound significantly improves the detection rate and test efficiency, quantifies RLS more accurately, and reduces testing risks and medical costs. We conclude that synchronous multimodal ultrasound has significant potential for clinical applications.
右向左分流（RLS）与多种病症相关且会引发发病。在本研究中，我们旨在评估同步多模式超声检查在检测RLS方面的有效性。
我们前瞻性地纳入了423例临床高度怀疑RLS的患者，并将他们分为对比经颅多普勒（cTCD）组和同步多模式超声组，在同步多模式超声组中，在超声造影成像的同一过程中同时进行cTCD和对比经胸超声心动图（cTTE）检查。将同步检查结果与单独进行cTCD的结果进行比较。
同步多模式超声组中II级（22.0%:10.0%）和III级（12.7%:10.8%）分流的阳性率以及总阳性率（82.1748%）均高于单独cTCD组。在同步多模式超声组中I级RLS患者中，23例在cTCD检查中为I级RLS，但同步cTTE检查中为0级，而4例在cTCD检查中为I级，但同步cTTE检查中为0级。在同步多模式超声组中II级RLS患者中，28例在cTCD检查中为I级RLS，但同步cTTE检查中为II级。在同步多模式超声组中III级RLS患者中，4例在cTCD检查中为I级RLS，但同步cTTE检查中为III级。同步多模式超声在卵圆孔未闭（PFO）诊断中的敏感性为87.5%，特异性为60.6%。二元逻辑回归分析显示，年龄（比值比[OR]=1.041）和矛盾栓塞风险评分≥7（OR=7.798）是卒中复发的危险因素，而抗血小板治疗（OR=0.590）和抗血小板治疗下的PFO封堵术（OR=0.109）是保护因素。
同步多模式超声显著提高了检测率和检查效率，更准确地对RLS进行量化，降低了检查风险和医疗成本。我们得出结论，同步多模式超声在临床应用中具有巨大潜力。
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