Department of Ultrasonography, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Department of Radiology, The 985th Hospital of PLA, Taiyuan, Shanxi, China.
Medicine (Baltimore). 2024 Sep 27;103(39):e39791. doi: 10.1097/MD.0000000000039791.
Right-to-left shunt (RLS) caused by patent foramen ovale (PFO) and pulmonary arteriovenous malformations (PAVM) have been associated with a variety of diseases, and reliable techniques for detecting RLS are essential for diagnosis. This study aimed to compare the diagnostic accuracy of multimodal ultrasound imaging, including transthoracic echocardiography (TTE) plus contrast transthoracic echocardiography (CTTE) and transesophageal echocardiography (TEE) plus contrast transesophageal echocardiography (CTEE) for PFO and PAVM in patients with cryptogenic stroke or migraine. This prospective study enrolled patients with cryptogenic stroke or migraine admitted to First Hospital of Shanxi Medical University between July 2018 and April 2023. The TTE + CTTE + TEE + CTEE multimodal ultrasound imaging was defined as the gold standard. A total of 230 patients with cryptogenic stroke (108) or migraine (122) were enrolled. The TEE + CTEE generated a better area under the receiver operator characteristic (ROC) curves (AUC) than TTE + CTTE [0.995 (0.988-1.000) vs 0.975 (0.767-0.984), P < .001], indicating better identification of PFO and PAVM. The sensitivity and specificity of the TTE + CTTE were 89.4% and 85.7%, respectively, whereas the sensitivity and specificity of TEE + CTEE were 99.1% and 100%, respectively. The missed diagnosis rate of TTE + CTTE and TEE + CTEE was 65.7 % and 12.5%, respectively. The combination of TEE + CTEE may be a more reliable and sensitive tool to detect PFO and PAVM than TTE + CTTE in patients with cryptogenic stroke or migraine.
右向左分流（RLS）由卵圆孔未闭（PFO）和肺动静脉畸形（PAVM）引起，与多种疾病相关，可靠的 RLS 检测技术对于诊断至关重要。本研究旨在比较多模态超声成像（包括经胸超声心动图（TTE）加对比经胸超声心动图（CTTE）和经食管超声心动图（TEE）加对比经食管超声心动图（CTEE））在隐源性卒中或偏头痛患者中检测 PFO 和 PAVM 的诊断准确性。这项前瞻性研究纳入了 2018 年 7 月至 2023 年 4 月期间在山西医科大学第一医院住院的隐源性卒中或偏头痛患者。TTE + CTTE + TEE + CTEE 多模态超声成像被定义为金标准。共纳入 230 例隐源性卒中（108 例）或偏头痛（122 例）患者。TEE + CTEE 生成的受试者工作特征（ROC）曲线下面积（AUC）优于 TTE + CTTE [0.995（0.988-1.000）比 0.975（0.767-0.984），P<0.001]，表明 PFO 和 PAVM 的识别能力更好。TTE + CTTE 的敏感性和特异性分别为 89.4%和 85.7%，而 TEE + CTEE 的敏感性和特异性分别为 99.1%和 100%。TTE + CTTE 和 TEE + CTEE 的漏诊率分别为 65.7%和 12.5%。与 TTE + CTTE 相比，TEE + CTEE 可能是一种更可靠和敏感的工具，可用于检测隐源性卒中或偏头痛患者的 PFO 和 PAVM。
