经胸超声心动图声学造影与对比增强经颅多普勒对卵圆孔未闭右向左分流的筛查价值  

Screening Value of Contrast Transthoracic Echocardiography and Contrast-Enhanced Transcranial Doppler in Right to Left Shunt of Patent Foramen Ovale

作　　者：田晓光 陈武[2] 徐琨[2] 刘晓芳[2] TIAN Xiaoguang;CHEN Wu;XU Kun;LIU Xiaofang(School of Medical Imaging,Shanxi Medical University,Taiyuan 030001,Shanxi,China;Department of Ultrasound,The First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China)

机构地区：[1]山西医科大学医学影像学院,山西太原030001 [2]山西医科大学第一医院超声科,山西太原030001

出　　处：《心血管病学进展》2022年第4期371-374,共4页Advances in Cardiovascular Diseases

基　　金：山西省卫生健康委科研课题(2019037)。

摘　　要：目的探讨经胸超声心动图声学造影(cTTE)与对比增强经颅多普勒(cTCD)对卵圆孔未闭右向左分流的筛查价值。方法选取2019年10月—2021年6月因偏头痛、不明原因脑卒中、头晕和短暂性脑缺血发作就诊于山西医科大学第一医院神经内科,临床高度怀疑卵圆孔未闭(PFO)的92例患者,行经食管超声心动图声学造影(cTEE)、cTTE和cTCD检查。右心房造影剂充分显影后,cTTE检查在3或5个心动周期内左心观察到微泡分别命名为cTTE3和cTTE5;cTCD半定量分级≥Ⅱ级命名为cTCDⅡ,cTCD半定量分级为Ⅲ级命名为cTCDⅢ;cTTE3+cTCDⅢ、cTTE5+cTCDⅡ分别为上述两种方法均阳性的联合检查。以cTEE为金标准,比较上述各种方法检测PFO的敏感性、特异性、阴性似然比(-LR)及误诊率。结果92例患者,cTEE检查有81例PFO阳性,11例PFO阴性。在充分的Valsalva动作下,cTTE3作为检测PFO阳性的截断值,敏感性、特异性、-LR和误诊率分别为52%、90%、59%和10%;同理,cTTE5的敏感性、特异性、-LR和误诊率分别为64%、80%、44%和20%。cTCDⅡ作为检测PFO阳性的截断值,敏感性、特异性、-LR和误诊率分别为76%、73%、36%和27%,同理;cTCDⅢ敏感性、特异性和-LR、误诊率分别为49%、90%、55%和9%。cTTE与cTCD联合诊断PFO,特异性提高,误诊率降低,尤其是cTTE3+cTCDⅢ联合,特异性达100%,误诊率为0。结论cTTE与cTCD单独应用对PFO的筛查具有较高的临床参考价值。二者联合应用均可以提高PFO诊断的特异性,尤其是以cTTE3+cTCDⅢ作为截断值。Objective To investigate the screening value of contrast transthoracic echocardiography(cTTE)and contrast-enhanced transcranial Doppler(cTCD)in the right to left shunt of patent foramen ovale.Methods A total of 92 patients with highly suspected patent foramen ovale(PFO)who were admitted to the Department of Neurology of The First Hospital of Shanxi Medical University from October 2019 to June 2021 due to migraine,unexplained stroke,dizziness,and transient ischemic attack were selected and examined for cTEE,cTTE and cTCD.After full development of right atrium contrast media by cTTE examination,microbubbles were observed in the left heart within 3 or 5 cardiac cycles,were named cTTE3 or cTTE5 respectively.cTCD semi-quantitative classification≥Ⅱwas named cTCDⅡ,and cTCD semi-quantitative classificationⅢwas named cTCDⅢ;cTTE3+cTCDⅢand cTTE5+cTCDⅡwere combined positive tests of the above two methods respectively.Using cTEE as the gold standard,the sensitivity,specificity,negative likelihood ratio(-LR)and misdiagnosis rate of PFO were compared.Results Among 92 patients,81 were PFO positive and 11 were PFO negative.Under sufficient Valsalva action,cTTE3 was used as the cutoff value for detecting positive PFO,and the sensitivity,specificity,-LR and misdiagnosis rate were 52%,90%,59%and 10%,respectively.Similarly,the sensitivity,specificity,-LR and misdiagnosis rate of cTTE5 were 64%,80%,44%and 20%,respectively.The sensitivity,specificity,-LR and misdiagnosis rate of cTCDⅡas the cutoff value of positive PFO were 76%,73%,36%and 27%,respectively.The sensitivity,specificity,-LR and misdiagnosis rate of cTCDⅢwere 49%,90%,55%and 9%,respectively.Combined diagnosis of PFO by cTTE and cTCD showed higher specificity and lower misdiagnosis rate,especially the combination of cTTE3+cTCDⅢshowed 100%specificity and 0 misdiagnosis rate.Conclusion The application of cTTE and cTCD alone has high clinical reference value for the screening of PFO.Combined application of the two methods can improve the specificity of PFO di

关 键 词：卵圆孔未闭 经胸超声心动图声学造影 对比增强经颅多普勒 经食管超声心动图声学造影 

分 类 号：R74[医药卫生—神经病学与精神病学]