应用对比经颅多谱勒超声诊断卵圆孔未闭的临床研究

Clinical study on the application of contrast transcranial Doppler in the diagnosis of patent foramen ovale

目的探讨对比经颅多谱勒超声(cTCD)诊断卵圆孔未闭(PFO)的敏感度、特异度、准确度及安全性。方法对45例缺血性脑血管病患者,自肘前静脉注射激活盐水作为造影剂,并结合Valsalva动作,进行cTCD和经食道超声心动图(TEE)检查或心脏介入检查,诊断PFO。结果 18例(40%)患者cTCD检查PFO阳性,27例阴性;对其中8例cTCD检查PFO阳性患者进行了TEE检查,7例TEE检查阳性,1例阴性,对该例阴性患者进行心脏介入检查,提示存在PFO;对其中2例cTCD检查PFO阴性者进行了TEE检查,2例TEE检查阴性。与TEE和心脏介入检查比较,cTCD诊断PFO的敏感度为100%,特异度为100%,准确度为100%。均无不良反应。结论 cTCD检测PFO的敏感度、特异度、准确度、安全性较高。

Objective To investigate the sensitivity, specificity, accuracy and safety in diagnosis of patent foramen ovale with contrast transcranial doppler （cTCD） . Methods PFO was assessed by performing cTCD and transesophageal echocardiography （TEE） with sonography with injection of agitated saline with Valsalva maneuver or cardiac interventional examination in 45consecutive patients with ischemic cerebrovascular disease（ICVD ）. Results 18 cases （40%） were PFO positive assessing by cTCD,27 cases were negative. 8 eases with cTCD positive were underwent TEE ,7 of which were TEE positive, 1 was negative （which was suggested PFO with cardiac interventional examination ）. Two patients with PFO negative diagnosed by cTCD were examined by TEE,which suggested negative results. Compared with TEE and cardiac interventional examination, the sensitivity, specificity and accuracy of diagnois PFO with cTCD was 100%, and no adverse reaction was found. Conclusion There are high sensitivity, specificity, accuracy and security in detection of PFO with cTCD.