隐源性缺血性脑卒中合并卵圆孔未闭的临床及影像学检查分析

Imaging diagnosis of cryptogenic cerebral apoplexy combined with patent foramen ovale

目的探讨卵圆孔未闭(PFO)伴隐源性缺血性脑卒中(CS)临床特点及不同影像学检查方法的优劣,研究卵圆孔未闭与隐源性脑卒中的相关性。方法选取2013年1月—2017年10月南昌大学第三附属医院收治的不明原因急性CS患者156例作为观察组,同时选取与观察组年龄、性别相匹配的健康体检者148例作为对照组。两组均行经胸右心声学造影和经颅多普勒对比增强试验(cTCD)诊断PFO,并比较两组PFO及PFO合并房间隔瘤(ASA)的发病率。以手术封堵结果为金标准,分析观察组中经胸右心声学造影和经颅c TCD两种检测方法有无差异。结果观察组的PFO及PFO合并ASA检出率与对照组比较,差异有统计学意义(P<0.05),观察组高于对照组;以手术结果为金标准,cTCD检出PFO的敏感性、特异性、准确性分别为75.8%(50/66)、88.9%(80/90)和83.3%(130/156);经胸右心声学造影检出PFO的敏感性、特异性、准确性分别为90.9%(60/66)、94.4%(85/90)和92.9%(145/156)。经胸右心声学造影在不明原因急性CS患者中检出PFO的敏感性、准确性均优于c TCD(P<0.05)。结论不明原因急性CS患者PFO发病率高于正常健康人群,其检查方法首选右心声学造影。经胸右心声学造影及c TCD诊断卵圆孔未闭具有确切的临床应用价值。

Objective To investigate different imaging methods for diagnosis of patent foramen ovale (PFO) with cryptogenic ischemic stroke (CS).Methods A retrospective analysis was carried out on 156 cases of acute ischemic stroke and 148 healthy subjects who were admitted into our hospital during January 2013 to October 2017.Chest right heart contrast echocardiography and transcranial Doppler contrast enhancement test (cTCD) were performed on all individuals.The incidence of PFO and atrial septal aneurysm (ASA) were identified.Diagnostic efficacy of two methods was evaluated.Results Incidence of PFO and PFO with ASA were higher in patient group than that in healthy control group (P<0.05).Sensitivity,specificity,and accuracy of cTCD was 75.8%(50/66),88.9%(80/90),and 83.3%(130/156),respectively.Sensitivity,specificity,and accuracy of transthoracic right heart contrast echocardiography was 90.9%(60/66),94.4%(85/90),and 92.9%(145/156),respectively.Transthoracic right heart contrast echocardiography exerted superiority in detecting PFO than cTCD did (P<0.05).Conclusions The incidence of PFO in patients with of unknown acute ischemic stroke is higher than that of normal healthy people.Right heart acoustic contrast is superior to cTCD in diagnosis of the patent foramen ovale.