Feasibility of evaluating right-to-left shunt by contrast-enhanced transcranial Doppler

doi:10.3877/cma.j.issn.1672-6448.2020.03.009

Abstract

Abstract:

Objective

To investigate the feasibility of evaluating right-to-left shunt (RLS) by contrast-enhanced transcranial Doppler (c-TCD).

Methods

From August 2015 to November 2018, 206 consecutive patients with cryptogenic stroke (CS) hospitalized at the Department of Neurology, First Affiliated Hospital of Soochow University were enrolled retrospectively and compared with 120 hospitalized patients with large-artery atherosclerosis (LAA) with regard to clinical features. All patients with CS underwent c-TCD and contrast echocardiography (c-TTE). RLS was considered permanent if it occurred during normal respiration or latent when it occurred only after the Valsalva maneuver. Some patients with large RLS assessed by c-TCD and positive for c-TTE underwent transesophageal echocardiography (TEE). The clinical features of patients with CS and patients with LAA were compared by t-test and χ²-test. The semi-quantitative classification of RLS by c-TCD and c-TTE was compared by Mann-Whitney rank sum test.

Results

The differences in age, hypertension, diabetes, hyperlipidemia, carotid plaque, smoking history, and plasma homocysteine between the CS group and LAA group were significant (t=-26.949, χ²=110.380、62.371、17.352、212.099、25.987、35.415, all P<0.001). The positive rates of c-TCD and c-TTE in the diagnosis of RLS were 70.4% (145/206 cases) and 46.6% (96/206 cases), respectively, and the difference was statistically significant (χ²=24.004, P<0.001). Of 145 cases of RLS detected by c-TCD, 96 had positive c-TTE results. Approximately 66.2% (96/145) of RLS cases diagnosed by c-TCD were confirmed by c-TTE. The positive rates of c-TTE were 78.5% (73/93 cases) and 44.2% (23/52 cases) for permanent and potential RLS assessed by c-TCD, respectively, and the differences were statistically significant (χ²=17.501, P<0.001). The positive rates of c-TTE were 23.7% (9/38 cases), 65.4% (17/26 cases), and 86.4% (70/81 cases) for small, moderate, and large RLS assessed by c-TCD, respectively, and the differences were statistically significant (χ²=11.129, 45.620, and 5.730, respectively; P<0.05). The semi-quantitative grade of RLS by c-TCD was significantly higher than that by c-TTE (Z=-6.021, P<0.001). Patent foramen ovale was confirmed in 92.9% (65/70) of cases.

Conclusion

c-TCD can accurately assess RLS and provide a reliable basis for individualized diagnosis and treatment of patients with cryptogenic stroke.

Key words: Contrast-enhanced, Transcranial Doppler, Right-to-left shunt, Contrast echocardiography, Cryptogenic stroke

Juyi Fu, Pinjing Hui, Yafang Ding, Yanhong Yan, Bai Zhang, Yongming He, Qi Fang. Feasibility of evaluating right-to-left shunt by contrast-enhanced transcranial Doppler[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(03): 255-261.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2020.03.009

https://chaosheng.cma-cmc.com.cn/EN/Y2020/V17/I03/255

Figures/Tables 7

References 14

1	Ning M, Lo EH, Ning PC, et al. The brain's heart-therapeutic opportunities for patent foramen ovale (PFO) and neurovascular disease [J]. Pharmacol Ther, 2013, 139(2): 111-123.
2	Lange MC, Zetola VF, de Souza AM, et al. Transcranial Doppler for patent foramen ovale screening: is there a good correlation with transesophageal echocardiography? [J]. Arq Neuropsiquiatr, 2008, 66(4): 785-789.
3	郭雨竹，邢英琦. 对比增强经颅多普勒超声诊断右向左分流相关问题探讨 [J]. 中国卒中杂志, 2016, 11(7): 515-529.
4	中华医学会心血管内科分会, 中国医师协会心血管内科分会. 卵圆孔未闭预防性封堵术中国专家共识 [J]. 中国循环杂志, 2017, 32(3): 209-214.
5	李越，翟亚楠，魏丽群, 等. 经食管与经胸超声心动图造影检出右向左分流效果比较 [J/CD]. 中华医学超声杂志(电子版), 2013, 10(11): 916-921.
6	Kent DM, Ruthazer R, Weimar C, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke [J]. Neurology, 2013, 81(7): 619-625.
7	韩艺华，邢英琦，陈嘉峰. 隐源性卒中病因学最新研究进展 [J].中国卒中杂志, 2015, 10(8): 691-696.
8	Zhou J, Austin RC. Contributions of hyperhomocysteinemia to atherosclerosis: causal relationship and potential mechanisms [J]. Biofactors, 2009, 35(2): 120-129.
9	Sastry S, Macnab A, Daly K, et al. Transcranial Doppler detection of venous-to-arterial circulation shunts: criteria for patent foramen ovale [J]. J Clin Ultrasound, 2009, 37(5): 276-280.
10	Belvis R, Leta RG, Marti-Fabregas J, et al. Almost perfect concordance between simultaneous transcranial Doppler and transesophageal echocardiography in the quantification of right-to-left shunts [J]. J Neuroimaging, 2006, 16(2): 133-138.
11	Mazzucco S, Li L, Binney L, et al. Oxford Vascular Study Phenotyped Cohort Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis [J]. Lancet Neurol, 2018, 17(7): 609-617.
12	Van H, Poommipanit P, Shalaby M, et al. Sensitivity of transcranial doppler versus intracardiac echocar-diography in the detection of right-to-left shunt [J]. JACC Cardiovasc Imaging. 2010, 3(4): 343-348.
13	Maillet A, Pavero A, Salaun P, et al. Transcranial Doppler to detect right to left communication: Evaluation versus transesophageal echocardiography in real life [J]. Angiology, 2018, 69(1): 79-82.
14	Souteyrand G, Motreff P, Lusson JR, et al. Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients [J]. Eur J Echocardiogr, 2006, 7(2): 147-154.

组别	年龄（岁，±s）	男性［例（%）］	高血压［例（%）］	糖尿病［例（%）］	高脂血症［例（%）］	颈动脉斑块［例（%）］	吸烟史［例（%）］	血浆Hcy升高［例（%）］
CS组	46.38±6.62	118（57.28）	42（20.39）	9（4.37）	18（8.73）	34（16.50）	41（19.90）	24（11.65）
LAA组	67.11±6.83	75（62.50）	96（80.00）	46（38.33）	31（25.83）	120（100.00）	56（46.67）	48（40.00）
统计值	t=-26.949	χ²=0.855	χ²=110.380	χ²=62.371	χ²=17.352	χ²=212.099	χ²=25.987	χ²=35.415
P值	<0.001	0.355	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

组别	年龄（岁，±s）	男性［例（%）］	高血压［例（%）］	糖尿病［例（%）］	高脂血症［例（%）］	颈动脉斑块［例（%）］	吸烟史［例（%）］	血浆Hcy升高［例（%）］
CS组	46.38±6.62	118（57.28）	42（20.39）	9（4.37）	18（8.73）	34（16.50）	41（19.90）	24（11.65）
LAA组	67.11±6.83	75（62.50）	96（80.00）	46（38.33）	31（25.83）	120（100.00）	56（46.67）	48（40.00）
统计值	t=-26.949	χ²=0.855	χ²=110.380	χ²=62.371	χ²=17.352	χ²=212.099	χ²=25.987	χ²=35.415
P值	<0.001	0.355	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

[1]	Qi Lyu, Pinjing Hui, Yafang Ding, Yanhong Yan. Carotid contrast-enhanced ultrasound assessment of plaque vulnerability and its correlation with ischemic stroke [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1040-1045.
[2]	Weiping Zhang, Jingling Wang, Zhixing Liu, Li Chen, Fangqun Chen. Characteristics of time-intensity curve of high-frame-rate contrast-enhanced ultrasound in clear cell renal cell carcinoma [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 916-922.
[3]	Miao Li, Lianhua Zhu, Peng Han, Bo Jiang, Xiang Fei. Evaluation of relationsip between vascular morphology and risk factors for hepatocellular carcinoma by high-frame-rate contrast-enhanced ultrasound [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 911-915.
[4]	Lianhua Zhu, Xiang Fei, Peng Han, Bo Jiang, Nan Li, Yukun Luo. Value of high frame rate contrast-enhanced ultrasound in differential diagnosis of gallbladder polyp lesions [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 904-910.
[5]	Qian Zhang, Jiahui Chen, Xuemeng Gao, Aoxue Zhao, Ying Huang. Value of radiomics features based on high-frame-rate contrast-enhanced ultrasound in differential diagnosis of benign and malignant thyroid nodules [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 895-903.
[6]	Lei Ding, Wen Luo, Xiao Yang, Lina Pang, Peidi Zhang, Haijing Liu, Jiani Yuan, Jin Liu. Application of high-frame-rate contrast-enhanced ultrasound in evaluation of imaging features of C-TIRADS 4-5 thyroid nodules [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 887-894.
[7]	Hua Shao, Ziyue Na, Hui Jing, Bo Li, Qiucheng Wang, Wen Cheng. Value of preoperative percutaneous contrast-enhanced ultrasound in diagnosis of axillary sentinel lymph node metastasis and burden in breast cancer [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 849-853.
[8]	Xu Zhang, Jianping Xu, Dongming Su, Caifen Wang, Dali Wang, Wenzhi Zhang. Contrast-enhanced ultrasound features of male breast masses [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 854-859.
[9]	Yingdong Xie, Guo Sun, Chaoli Xu, Bin Yang, Hui Sun, Yun Dai. Clinical value of quantitative contrast-enhanced ultrasound in evaluation of blood perfusion of transplanted kidney at different survival stages [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 749-754.
[10]	Hanyu Wang, Sike Zhang, Yu Zhang, Xin Wan, Qiuxia He, Mingming Li, Xiuhua Yang. Application value of intraoperative contrast-enhanced ultrasound in surgical resection of glioma [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 755-760.
[11]	Jiachun Jiang, Xiaobing Wang, Peirong Chen, Shihao Xu. Clinical value of serological indicators combined with conventional ultrasound and contrast-enhanced ultrasound scoring in diagnosis of primary Sjögren's syndrome [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 622-630.
[12]	Min Zhao, Yilu Shi, Shasha Duan, Yaxi Wang, Jie Zhao, Haiyue Zhao, Lu Zhang, Tianhao Bai, Xiaoshan Zhang. Quantitative assessment of synovial neovascularization in rheumatoid arthritis by high-frequency contrast-enhanced ultrasound with arginylglycylaspartic acid microbubbles [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(05): 530-536.
[13]	Zhiming Li, Chenming Guo, Xiaochen Zhuang, Xueqin Hou, Junxi Gao. Comparative study of qualitative and quantitative indicators of contrast-enhanced ultrasound in early breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 639-643.
[14]	Mei Liao, Hongjun Zhang, Jieyang Jin, Yan Lyu, Jie Ren. Diagnostic value of bedside contrast-enhanced ultrasound for early hepatic artery thrombosis after liver transplantation [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 630-634.
[15]	Fengyun Wu, Xin Teng, Lianjuan Liu. Diagnostic value of high-frequency ultrasonography and enhanced magnetic resonance for primary hyperdifferentiated hepatocellular carcinoma of different diameters [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 404-408.

Please choose a citation manager

Content to export