超声造影在卵圆孔未闭检测中的诊断价值。
Diagnostic value of contrast-enhanced ultrasonography for patent foramen ovale detection.
作者信息
Xu Kun, Tian Xiaoguang, Hao Meifang, Li Yiying, Zhang Jingxuan, Wong Randolph H L, Othmani Adrianna, Zhang Quanbin
机构信息
The First Hospital of Shanxi Medical University, Taiyuan, China.
The Fifth Hospital of Shanxi Medical University, Taiyuan, China.
出版信息
J Thorac Dis. 2024 May 31;16(5):3282-3290. doi: 10.21037/jtd-24-330. Epub 2024 May 21.
BACKGROUND
Patent foramen ovale (PFO) has been associated with migraine, cryptogenic stroke (CS), and hypoxemia. However, which examination method is most reliable remains controversial. This study sought to investigate the diagnostic value of contrast-enhanced ultrasonography (cU), including contrast-enhanced transcranial Doppler (cTCD), contrast transthoracic echocardiography (cTTE), and contrast transesophageal echocardiography (cTEE), for PFO; and to determine the best diagnostic strategy.
METHODS
This retrospective observational study included a total of 147 consecutive patients suspected PFO at The First Hospital of Shanxi Medical University between October 2019 and January 2022. The patients also underwent cTCD, cTTE, and cTEE examinations. The standard for the diagnosis of PFO was confirmation of the presence of PFO by color Doppler flow signals or contrast microbubbles (MBs) passing through the foramen ovale.
RESULTS
A total of 123 patients were diagnosed with PFO and 24 patients without PFO during the study period. The detectable rates of cTCD, cTTE, and cTEE were 120 (97.56%), 110 (89.43%), and 121 (98.37%), respectively. The sensitivity between cTCD and cTEE for PFO were comparable [97.56%, 95% confidence interval (CI): 92.5% to 99.4% . 98.37%, 95% CI: 93.7% to 99.7%; P>0.99], and the sensitivity of both were higher than that of cTTE (89.43%, 95% CI: 82.3% to 94.0%; P=0.02 and P=0.001, respectively). In addition, the specificity of cTEE for PFO was significantly higher than that of cTCD (100%, 95% CI: 82.3% to 100.0% . 75.00%, 95% CI: 53.0% to 89.4%; P<0.001) and cTTE (100%, 95% CI: 82.3% to 100.0% . 75.00%, 95% CI: 53.0% to 89.4%; P<0.001). Further, the semi-quantitative classification ability of cTCD for PFO with right-to-left shunt (RLS) was significantly higher than that of cTTE and cTEE (P=0.02 and P<0.001, respectively), and that of cTTE was significantly higher than that of cTEE (P=0.01). The Spearman analysis showed that the degree of RLS was positively correlated with the inner diameter of the PFO (r=0.695, P<0.001).
CONCLUSIONS
The combination of cTCD and cTEE may provide a favorable strategy for the diagnosis of PFO.
背景
卵圆孔未闭（PFO）与偏头痛、不明原因卒中（CS）及低氧血症相关。然而，哪种检查方法最可靠仍存在争议。本研究旨在探讨对比增强超声心动图（cU），包括对比增强经颅多普勒超声（cTCD）、对比增强经胸超声心动图（cTTE）和对比增强经食管超声心动图（cTEE）对PFO的诊断价值；并确定最佳诊断策略。
方法
本回顾性观察性研究纳入了2019年10月至2022年1月期间在山西医科大学第一医院连续就诊的147例疑似PFO患者。这些患者还接受了cTCD、cTTE和cTEE检查。PFO的诊断标准是通过彩色多普勒血流信号或对比微泡（MBs）穿过卵圆孔来确认PFO的存在。
结果
研究期间，共有123例患者被诊断为PFO，24例患者未患PFO。cTCD、cTTE和cTEE的检出率分别为120例（97.56%）、110例（89.43%）和121例（98.37%）。cTCD和cTEE对PFO的敏感性相当[97.56%，95%置信区间（CI）：92.5%至99.4%；98.37%，95%CI：93.7%至99.7%；P>0.99]，且两者的敏感性均高于cTTE（89.43%，95%CI：82.3%至94.0%；P分别为0.02和0.001）。此外，cTEE对PFO的特异性显著高于cTCD（100%，95%CI：82.3%至100.0%；75.00%，95%CI：53.0%至89.4%；P<0.001）和cTTE（100%，95%CI：82.3%至100.0%；75.00%，95%CI：53.0%至89.4%；P<0.001）。此外，cTCD对PFO伴右向左分流（RLS）的半定量分级能力显著高于cTTE和cTEE（P分别为0.02和<0.001），且cTTE的半定量分级能力显著高于cTEE（P=0.01）。Spearman分析显示，RLS程度与PFO内径呈正相关（r=0.695，P<0.001）。
结论
cTCD和cTEE联合应用可能为PFO的诊断提供良好策略。
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