联合声学造影对卵圆孔未闭右向左分流的诊断价值

伍士芳; 雍永宏; 许伟; 孙红光

doi:10.7619/jcmp.20222873

联合声学造影对卵圆孔未闭右向左分流的诊断价值

Diagnostic value of combined contrast-enhanced ultrasonography in right to left shunt of patent foramen ovale

摘要

摘要:
目的探讨经颅多普勒超声声学造影（cTCD）联合经胸超声心动图声学造影（cTTE）在卵圆孔未闭（PFO）诊断和介入治疗中的应用价值。
方法本研究纳入南京医科大学第一附属医院收治的112例高度疑似PFO的患者，所有患者均行cTCD、cTTE和经食道超声心动图（TEE）检查，评估PFO右向左分流（RLS）分级情况。以经导管PFO探查封堵术结果为金标准，比较cTCD联合cTTE和cTCD联合TEE对PFO的诊断效能的差异。
结果 cTCD联合cTEE的诊断敏感度、准确度分别为98.1%、93.8%，略高于cTCD联合TEE的96.2%、91.1%，但差异无统计学意义（P>0.05）。112例高度疑似PFO患者中，行封堵术106例（94.6%），术后随访6~12个月，患者无明显手术相关并发症，无卒中复发，83.1%有不同程度偏头痛的患者得到缓解。
结论 cTCD联合cTTE可以准确判断RLS来源及严重程度，敏感度和准确度较高，可以用于临床PFO的筛查。

Abstract:
Objective To explore the value of contrast-enhanced transcranial Doppler (cTCD) combined with contrast transthoracic echocardiography (cTTE) in the diagnosis and interventional treatment of patent foramen ovale (PFO).
Methods A total of 112 patients with highly suspected PFO admitted to the First Affiliated Hospital of Nanjing Medical University were recruited. All patients underwent cTCD, cTTE and transesophageal echocardiography(TEE)to evaluate the classification of right to left shunt (RLS) of PFO. Taking the results of transcatheter PFO exploration and occlusion as the'gold standard', the diagnostic efficacy of cTCD combined with cTTE and cTCD combined with TEE for diagnosis of PFO was compared.
Results The diagnostic sensitivity and accuracy of cTCD combined with cTEE were 98.1% and 93.8%, respectively, which were slightly higher than 96.2% and 91.1% of cTCD combined with TEE, but it showed no statistically significant difference (P>0.05). Among the 112 patients with highly suspected PFO, 106 cases (94.6%) received occlusion and were followed up for 6 to 12 months. No significant surgery-related complications or stroke recurrence were found in the patients, and 83.1% of the patients with migraines of varying degrees were relieved.
Conclusion The method of cTCD combined with cTT can accurately judge the source and severity of RLS with high sensitivity and accuracy. Therefore, it can be used in PFO screening.

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