Zhang Dian, Jiang Li, Chen Yue-Nan, Pan Mei-Fang
Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, China.
Front Neurol. 2024 Aug 2;15:1447964. doi: 10.3389/fneur.2024.1447964. eCollection 2024.
To evaluate and compare the diagnostic value of contrast-enhanced transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) for right to left shunt (RLS) in patent foramen ovale (PFO) by meta-analysis.
The literature included in the Cochrane Library, PubMed, and Embase were searched by using "contrast-enhanced transcranial Doppler (c-TCD), contrast-enhanced transthoracic echocardiography (c-TTE), patent foramen ovale (PFO), and right to left shunt (RLS)" as the keywords from inception through April 30, 2024. The diagnostic accuracy research quality assessment tool (QUADAS-2) was used to evaluate the quality of the included literature. The combined sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and Diagnostic odds ratio (DOR) were pooled, and a comprehensive ROC curve analysis was performed. Statistical software StataSE 12.0 and Meta-Disc 1.4 were used for data analysis.
A total of 8,536 articles were retrieved, and 9 articles that met all inclusion criteria were included in this meta-analysis. The meta-analysis results show that the combined sensitivity, specificity, PLR, NLR, DOR, and area under the SROC curve of c-TCD for the diagnose of PFO-RLS were 0.91 (95% CI, 0.88-0.93), 0.87 (95% CI: 0.84-0.91), 6.0 (95% CI, 2.78-12.96), 0.10 (95% CI, 0.06-0.18), 91.61 (95% CI, 26.55-316.10), and 0.9681, respectively; the corresponding values of c-TTE were 0.86 (95% CI, 0.84-0.89), 0.88 (95% CI, 0.84-0.91), 5.21 (95% CI, 2.55-10.63), 0.16 (95% CI, 0.09-0.31), 71.43 (95% CI, 22.85-223.23), and 0.9532. The ROC curve shows that c-TCD has slightly higher diagnostic value for PFO than c-TTE, but there is no significant statistical difference (Z = 0.622, > 0.05). Deek funnel pattern showed no significant publication bias.
Both c-TCD and c-TTE have high diagnostic values for PFO-RLS. However, c-TCD has slightly higher sensitivity and lower specificity in diagnosing PFO-RLS compared to c-TTE. identifier [CRD42024544169].
通过荟萃分析评估和比较对比增强经颅多普勒（c-TCD）和对比增强经胸超声心动图（c-TTE）对卵圆孔未闭（PFO）中右向左分流（RLS）的诊断价值。
以“对比增强经颅多普勒（c-TCD）、对比增强经胸超声心动图（c-TTE）、卵圆孔未闭（PFO）、右向左分流（RLS）”为关键词，检索Cochrane图书馆、PubMed和Embase中从创刊至2024年4月30日的文献。采用诊断准确性研究质量评估工具（QUADAS-2）评估纳入文献的质量。汇总合并敏感度、特异度、阳性似然比（PLR）、阴性似然比（NLR）和诊断比值比（DOR），并进行全面的ROC曲线分析。使用统计软件StataSE 12.0和Meta-Disc 1.4进行数据分析。
共检索到8536篇文章，9篇符合所有纳入标准的文章被纳入本荟萃分析。荟萃分析结果显示，c-TCD诊断PFO-RLS的合并敏感度、特异度、PLR、NLR、DOR及SROC曲线下面积分别为0.91（95%CI，0.88-0.93）、0.87（95%CI：0.84-0.9）、6.0（95%CI，2.78-12.96）、0.10（9%CI，0.06-0.18）、91.61（95%CI，26.55-316.10）和0.9681；c-TTE的相应值分别为0.86（95%CI，0.84-0.89）、0.88（95%CI，0.84-0.91）、5.21（95%CI，2.55-10.63）、0.16（95%CI，0.09-0.31）、71.43（95%CI，22.85-223.23）和0.9532。ROC曲线显示，c-TCD对PFO的诊断价值略高于c-TTE，但差异无统计学意义（Z=0.622，P>0.05）。Deek漏斗图显示无明显发表偏倚。
c-TCD和c-TTE对PFO-RLS均具有较高的诊断价值。然而，与c-TTE相比，c-TCD在诊断PFO-RLS时具有略高的敏感度和较低的特异度。标识符[CRD42024544169]。
