Contrast transoesophageal echocardiography remains superior to contrast-enhanced cardiac magnetic resonance imaging for the diagnosis of patent foramen ovale
Contrast transoesophageal echocardiography remains superior to contrast-enhanced cardiac magnetic resonance imaging for the diagnosis of patent foramen ovale
复制标题
DOI：
10.1093/ejechocard/jeq177
复制
发表时间：
2011-03-01
影响因子：
--
通讯作者：
Lanza, G. A.
中科院分区：
文献类型：
--
作者：
Hamilton-Craig, C.;Sestito, A.;Lanza, G. A.
在30-40%的急性缺血性卒中患者中，病因仍未明确（隐源性卒中）。经食管超声心动图（TEE）被认为是检测卵圆孔未闭（PFO）的金标准。然而，最近，心脏磁共振（CMR）也被应用于检测PFO。在这项研究中，我们比较了CMR和TEE的诊断价值，在检测PFO在一组患者明显隐源性strok.Methods和结果25例（年龄50 +/- 13岁，16名男性），明显隐源性缺血性中风进行对比增强的TEE和对比CMR检测可能的PFO。两项成像研究均在Valsalva动作期间进行。根据左心房中造影剂通道的实体，对TEE和CMR的PFO分级结果进行了目视评估（0级=无PFO; 1级、2级和3级分别=轻度、中度和广泛PFO）。TEE检出PFO 16例（64%）。对比增强CMR在7例（44%）患者中发现PFO。TEE显示5例患者为1级PFO，8例患者为2级PFO，3例患者为3级PFO。在这些患者中，CMR未能识别所有5名1级PFO患者的PFO，1名2级PFO患者和1名3级PFO患者（根据TEE）。TEE检查无PFO的9例患者在CMR检查中均未显示PFO。与TEE相比，CMR的敏感性为50%，特异性为100%，阴性预测值为31%，阳性预测值为100%。结论TEE是诊断缺血性脑卒中患者PFO的基础性影像学检查，优于CMR序列。
Aims In 30-40% of patients with acute ischaemic stroke, the cause remains undefined (cryptogenic stroke). Contrast transoesophageal echocardiography (TEE) is considered the gold standard for patent foramen ovale (PFO) detection. Recently, however, cardiac magnetic resonance (CMR) has also been applied to detect PFO. In this study, we compared the diagnostic value of CMR and TEE in detecting PFO in a group of patients with apparently cryptogenic stroke.Methods and results Twenty-five patients (age 50 +/- 13 years, 16 males) with apparently cryptogenic ischaemic stroke underwent contrast-enhanced TEE and contrast CMR for detection of possible PFO. Both imaging studies were performed during Valsalva manoeuvre. PFO grading results were assessed visually both for TEE and for CMR, according to the entity of contrast passage in the left atrium (grade 0 = no PFO; grades 1, 2, and 3 = mild, medium, and wide PFO, respectively). TEE detected PFO in 16 patients (64%). Contrast-enhanced CMR identified a PFO in 7 (44%) of these patients. TEE showed a grade 1 PFO in five patients, a grade 2 PFO in eight patients, and a grade 3 PFO in three patients. Of these patients, CMR failed to identify PFO in all five patients with a grade 1 PFO, in one patient with a grade 2 PFO, and one patient with grade 3 PFO according to TEE. None of the nine patients without PFO at TEE was shown to have a PFO at CMR. When compared with TEE, the present methodology of CMR had a sensitivity of 50%, specificity of 100%, negative predictive value of 31%, and a positive predictive value of 100%.Conclusion Our data suggest that TEE is the cornerstone imaging diagnostic test to detect and characterize PFO in patients with ischaemic stroke, and is shown to be better compared with the current CMR sequences.