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

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Man-Juan Yao, Ying-Ying Zhao, Shui-Ping Deng, Hua-Hua Xiong, Jing Wang, Li-Jie Ren, Li-Ming Cao
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引用次数: 0

Abstract

Background: Patent foramen ovale (PFO)-related right-to-left shunts (RLSs) have been implicated 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 examinations.

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.

同步经颅多普勒造影联合经胸超声心动图造影检测右至左分流的初步研究。
背景:卵圆孔未闭(PFO)相关的右至左分流(RLSs)与隐源性卒中和偏头痛有关,较大的分流风险更高。当单独用于检测RLS时,经颅多普勒造影(cTCD)和经胸超声心动图造影(cTTE)可能会产生假阴性结果。此外,文献揭示了对cTCD和cTTE局限性的理解差距,对它们的独家使用提出了相互矛盾的建议,并强调了与非同步测试相关的低效率。目的:探讨多模态超声诊断pfo相关性RLSs的准确性,提高诊断效率。方法:我们前瞻性地招募了4例隐源性卒中(n = 1)、偏头痛(n = 2)和不明原因头晕(n = 1)的患者,他们接受了同步cTCD联合cTTE治疗。对参与者进行了为期24个月的监测和随访。结果:cTTE在复发性隐源性卒中和偏头痛患者中发现了中度和较大的RLSs,而cTCD仅发现了较小的RLSs。经cTTE和cTCD联合治疗,证实有中度和重度RLS。排除其他原因后,两例患者均行PFO闭塞。在21个月和24个月的随访检查中,中风和偏头痛都没有复发。cTTE显示,第三例患者出现小的睡眠倒睡,伴有不明原因的头晕,第四例患者伴有偏头痛;然而,同时cTCD检测到较大的RLS。这些患者未接受介入性闭塞治疗,17个月和24个月随访检查时再次出现头晕和头痛。结论:使用cTTE或cTCD可能会低估RLS,损害风险评估。同步cTCD与cTTE结合可以提高检测的准确性,支持更好的诊断和治疗决策。
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来源期刊
World journal of radiology
World journal of radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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8.00%
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