Right-to-left shunt detection via synchronized contrast transcranial Doppler combined with contrast transthoracic echocardiography:A preliminary study  

作　　者：Man-Juan Yao Ying-Ying Zhao Shui-Ping Deng Hua-Hua Xiong Jing Wang Li-Jie Ren Li-Ming Cao 

机构地区：[1]Department of Neurology,The First Affiliated Hospital of Shenzhen University,Shenzhen 518000,Guangdong Province,China [2]Department of Rehabilitation,Shenzhen Dapeng New District Nan'ao People's Hospital,Shenzhen 518121,Guangdong Province,China [3]Department of Ultrasound,The First Affiliated Hospital of Shenzhen University,Shenzhen 518000,Guangdong Province,China [4]Department of Ultrasound,Shenzhen Second People's Hospital,Shenzhen 518000,Guangdong Province,China [5]Department of Neurology,Shenzhen Second People's Hospital,Shenzhen 518000,Guangdong Province,China [6]Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations,Changsha Medical University,Changsha 410000,Hunan Province,China

出　　处：《World Journal of Radiology》2024年第11期657-667,共11页世界放射学杂志（英文）

基　　金：Supported by The Shenzhen Second People’s Hospital Clinical Research Fund of the Shenzhen High-level Hospital Construction Project,No.20223357021 and No.20243357001;Research Project of Teaching Reform in Shenzhen Second People’s Hospital,No.202209;Guangdong Province Basic and Applied Basic Research Fund Project,No.2020B1515120061.

摘　　要：BACKGROUND Patent foramen ovale(PFO)-related right-to-left shunts(RLSs)have been impli-cated 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.AIM To investigate the accuracy of multimodal ultrasound to improve diagnostic efficiency in detecting PFO-related RLSs.METHODS We prospectively enrolled four patients with cryptogenic stroke(n=1),migraine(n=2),and unexplained dizziness(n=1)who underwent synchronized cTCD combined with cTTE.The participants were monitored and followed-up for 24 months.RESULTS 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 examin-ations.CONCLUSION 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.

关 键 词：Contrast transcranial Doppler Contrast transthoracic echocardiography Cryptogenic stroke Multimodal ultrasonography Patent foramen ovale Right-to-left shunt 

分 类 号：R575.2[医药卫生—消化系统]