Yao Man-Juan, Zhao Ying-Ying, Deng Shui-Ping, Xiong Hua-Hua, Wang Jing, Ren Li-Jie, Cao Li-Ming
Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China.
Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen 518121, Guangdong Province, China.
World J Radiol. 2024 Nov 28;16(11):657-667. doi: 10.4329/wjr.v16.i11.657.
Patent foramen ovale (PFO)-related right-to-left shunts (RLSs) have been implicated in cryptogenic stroke and migraine, with larger shunts posing a higher risk. When used individually to detect RLS, contrast transcranial Doppler (cTCD) and contrast transthoracic echocardiography (cTTE) may yield false-negative results. Further, the literature exposes gaps regarding the understanding of the limitations of cTCD and cTTE, presents conflicting recommendations on their exclusive use, and highlights inefficiencies associated with nonsynchronous testing.
To investigate the accuracy of multimodal ultrasound to improve diagnostic efficiency in detecting PFO-related RLSs.
We prospectively enrolled four patients with cryptogenic stroke ( = 1), migraine ( = 2), and unexplained dizziness ( = 1) who underwent synchronized cTCD combined with cTTE. The participants were monitored and followed-up for 24 months.
cTTE identified moderate and large RLSs in patients with recurrent cryptogenic stroke and migraines, whereas cTCD revealed only small RLSs. Moderate and large RLS were confirmed on combined cTTE and cTCD. After excluding other causes, both patients underwent PFO occlusion. At 21- and 24-month follow-up examinations, neither stroke nor migraine had recurred. cTTE revealed a small RLS in a third patient with unexplained dizziness and a fourth patient with migraines; however, simultaneous cTCD detected a large RLS. These patients did not undergo interventional occlusion, and dizziness and headache recurred at the 17- and 24-month follow-up examinations.
Using cTTE or cTCD may underestimate RLS, impairing risk assessments. Combining synchronized cTCD with cTTE could enhance testing accuracy and support better diagnostic and therapeutic decisions.
卵圆孔未闭（PFO）相关的右向左分流（RLS）与不明原因卒中及偏头痛有关，分流越大，风险越高。单独使用对比经颅多普勒（cTCD）和对比经胸超声心动图（cTTE）检测RLS时，可能会出现假阴性结果。此外，文献表明，对于cTCD和cTTE局限性的理解存在差距，对于单独使用它们给出了相互矛盾的建议，并突出了非同步检测的低效性。
研究多模态超声在提高检测PFO相关RLS诊断效率方面的准确性。
我们前瞻性纳入了4例患者，分别为不明原因卒中（n = 1）、偏头痛（n = 2）和不明原因头晕（n = 1），均接受同步cTCD联合cTTE检查。对参与者进行了24个月的监测和随访。
cTTE在复发性不明原因卒中和偏头痛患者中发现了中度和大量RLS，而cTCD仅发现了少量RLS。联合cTTE和cTCD证实存在中度和大量RLS。排除其他病因后，这2例患者均接受了PFO封堵术。在21个月和24个月的随访检查中，卒中及偏头痛均未复发。cTTE在第3例不明原因头晕患者和第4例偏头痛患者中发现了少量RLS；然而，同步cTCD检测到大量RLS。这些患者未接受介入封堵，在17个月和24个月的随访检查中头晕和头痛复发。
使用cTTE或cTCD可能会低估RLS，影响风险评估。将同步cTCD与cTTE相结合可提高检测准确性，并有助于做出更好的诊断和治疗决策。
