经颅多普勒发泡试验及经胸右心造影筛查卵圆孔未闭的应用价值

Application value of contrast transcranial Doppler and contrast transthoracic echocardiography in screening-patent foramen ovale

目的探讨经颅多普勒发泡试验(cTCD)及经胸右心造影(cTTE)筛查卵圆孔未闭(PFO)的应用价值.方法回顾性分析我院神经内科不明原因脑卒中、黑朦、偏头痛185例患者,所有患者均行普通经胸超声心动图(TTE)、cTTE及cTCD,其中46例并行经食道超声心动图(TEE)检查.以TEE为金标准,比较TTE、cTTE、cTCD3种方法检测PFO的效能.结果cTCD对PFO的检出率是71.4%、敏感度是94.1%、特异度是75.0%;cTTE对PFO的检出率是57.3%、敏感度是73.4%、特异度是91.7%;TTE对PFO的检出率是21.6%,敏感度是26.5%、特异度是41.7%.cTCD及cTTE对PFO的检出率、敏感度及特异度均明显高于TTE;cTCD的敏感度高于cTTE,但特异度低于cTTE.cTCD检测少量右向左分流(RLS)的能力高于cTTE;但cTCD与cTTE诊断中大量RLS的能力差异无统计学意义.结论cTCD对PFO的检出率、敏感度较高,但特异度较cTTE低,无法判别RLS的位置,有一定的假阳性;cTTE诊断PFO的特异度极高,但敏感度较cTCD低,有一定的假阴性.

Objective To explore the application value of contrast transcranial Doppler and contrast transthoracic echocardiography in screening patent foramen ovale(PFO).Methods A total of 185 patients with stroke of unknown cause, amaurosis, migraine in the department of neurology of our hospital were analyzed retrospectively.All the patients were given transthoracic echocardiograph(TTE),contrast transthoracic echocardiography(cTTE) and contrast transcranial doppler(cTCD).Forty-six patients were also given transesophageal echocardiography(TEE) examination.Taken TEE outcomes as golden standards, the efficacies of TTE,cTTE and cTCD for diagnosing PFO were compared.Results The detection rate, sensitivity and specificity of cTCD were 71.4%,94.1% and 75.0% respectively;the detection rate, sensitivity and specificity of cTTE were 57.3%,73.4% and 91.7% respectively;the detection rate, sensitivity and specificity of TTE were 21.6%,26.5% and 41.7% respectively.The detection rate, sensitivity and specificity of cTCD and cTTE were significantly higher than those of TTE.cTCD were more sensitive than cTTE,but less specific than cTTE.The ability of cTCD for detecting small amount of right-to-left shunt(RLS) were higher than that of cTTE.However, there were no difference between cTCD and cTTE in the ability for detecting medium and large number of RLS.Conclusion cTCD has higher detection rate and sensitivity for diagnosing PFO,but its specificity is lower than that of cTTE,and it is difficult to detect the location of RLS and has certain false positive.The specificity of cTTE for diagnosing PFO is very high, but its sensitivity is lower than that of cTCD,with certain false negative.