Detection of right-to-left shunts: Comparison between the international consensus and Spencer Logarithmic Scale criteria
Detection of right-to-left shunts: Comparison between the international consensus and Spencer Logarithmic Scale criteria
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DOI：
10.1111/j.1552-6569.2007.00218.x
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发表时间：
2008-10-01
影响因子：
2.4
通讯作者：
Alexandrov, Andrei V.
中科院分区：
文献类型：
--
作者：
Lao, Annabelle Y.;Sharma, Vijay K.;Alexandrov, Andrei V.
背景：国际共识标准(ICC)认为，当经颅多普勒(TCD)检测到一个微泡(MuB)时，就会出现右向左分流(RLS)。斯宾塞对数标尺(SLS)提供了更多等级的RLS，检测到的>；30muB对应于大分流。我们比较了ICC和SLS在检测和量化大RLS方面的效果。SUBJECTS和METHODS我们前瞻性地评估了连续发生缺血性卒中或短暂性脑缺血发作(TIA)的患者中矛盾栓塞症的发生。结果按ICC[阴性(无B亩)、I级(1~20亩B)、II级(20亩B或淋浴状)、III级(无B亩)]和SLS标准[阴性(无B亩)、I级(1~10亩B)、II级(11~30亩B)、III级(31100亩B)、IV级(101300亩B)、V级(300亩B)]进行分类。结果经食道超声心动图与经食道超声心动图比较，真阳性24例，真阴性48例，假阳性4例，假阴性2例(敏感性92.3%，特异性92.3%，阳性预测值(PPV)85.7%，阴性预测值(NPV)96%，准确性92.3%)。ICC和SLS对大型RLS的诊断均为100%敏感。与TEE相比，ICC和SLS标准的假阳性率分别为24.4%和7.7%。结论虽然两种分级标准对TEE是否存在分流具有一致性，但使用Spencer分级III或更高级别的TCD可以减少一半的假阳性TCD诊断，以预测TEE上较大的RLS。
BACKGROUNDInternational Consensus Criteria (ICC) consider right-to-left shunt (RLS) present when Transcranial Doppler (TCD) detects even one microbubble (mu B). Spencer Logarithmic Scale (SLS) offers more grades of RLS with detection of >30 mu B corresponding to a large shunt. We compared the yield of ICC and SLS in detection and quantification of a large RLS.SUBJECTS AND METHODSWe prospectively evaluated paradoxical embolism in consecutive patients with ischemic strokes or transient ischemic attack (TIA) using injections of 9 cc saline agitated with 1 cc of air. Results were classified according to ICC [negative (no mu B), grade I (1-20 mu B), grade II (>20 mu B or "shower" appearance of mu B), and grade III ("curtain" appearance of mu B)] and SLS criteria [negative (no mu B), grade I (1-10 mu B), grade II (11-30 mu B), grade III (31100 mu B), grade IV (101300 mu B), grade V (>300 mu B)]. The RLS size was defined as large (>4 mm) using diameter measurement of the septal defects on transesophageal echocardiography (TEE).RESULTSTCD comparison to TEE showed 24 true positive, 48 true negative, 4 false positive, and 2 false negative cases (sensitivity 92.3%, specificity 92.3%, positive predictive value (PPV) 85.7%, negative predictive value (NPV) 96%, and accuracy 92.3%) for any RLS presence. Both ICC and SLS were 100% sensitive for detection of large RLS. ICC and SLS criteria yielded a false positive rate of 24.4% and 7.7%, respectively when compared to TEE.CONCLUSIONSAlthough both grading scales provide agreement as to any shunt presence, using the Spencer Scale grade III or higher can decrease by one-half the number of false positive TCD diagnoses to predict large RLS on TEE.