摘要
目的对比观察经颅多普勒(TCD)发泡试验、经胸超声心动图(TTE)右心造影及颈胸联合超声造影诊断卵圆孔未闭(PFO)右向左分流(RLS)的价值。方法对39例PFO-RLS患者先后行TCD发泡试验、TTE右心造影、颈胸联合超声造影和经食管超声心动图(TEE)检查,以TEE为金标准,观察前三者诊断PFO-RLS的能力。结果TTE右心造影和颈胸联合超声造影诊断PFO-RLS的特异度均为100%,TTE右心造影的敏感度(53.49%)及准确率(54.85%)均低于TCD发泡试验(敏感度93.02%,准确率95.35%)和颈胸联合超声造影(敏感度90.69%,准确率95.23%)(P均<0.05);TCD发泡试验与颈胸联合超声造影的诊断敏感度、准确率及检出不同分流量PFO-RLS能力差异均无统计学意义(P均>0.05),且诊断一致性极高(Kappa=0.852)。TCD发泡试验和颈胸联合超声造影检出少量PFO-RLS的能力均高于TTE右心造影(P均<0.05),与后二者诊断结果的一致性分别为中等和一般(Kappa=0.429、0.311)。结论TCD发泡试验诊断PFO-RLS敏感度和准确率较高,但难以判断RLS位置;TTE右心造影诊断PFO-RLS特异度极高,但敏感度和准确率欠佳,尤其对少量PFO-RLS;颈胸联合超声造影有较高诊断特异度、敏感度和准确率,可检出少量PFO-RLS,并有助于判断RLS位置。
Objective To compare the value of transcranial Doppler(TCD)bubble test,transthoracic echocardiography(TTE)right cardiography and cervicothoracic contrast-enhanced ultrasound for diagnosing right-to-left shunt(RLS)of patent foramen ovale(PFO).Methods A total of 39 patients with PFO-RLS underwent series examinations,including TCD bubble test,TTE right cardiography,cervicothoracic contrast-enhanced ultrasound and transesophageal ultrasound(TEE).Taken TEE outcomes as golden standards,the efficacies of the former 3 methods for diagnosing PFO-RLS were observed and compared.Results The specificity of TTE right cardiography and cervicothoracic contrast-enhanced ultrasound for diagnosing PFO-RLS were both 100%,but the sensitivity(53.49%)and accuracy(54.85%)of TTE right cardiography were lower than those of TCD bubble test(sensitivity 93.02%,accuracy 95.35%)and cervicothoracic contrast-enhanced ultrasound(sensitivity 90.69%,accuracy 95.23%)(all P<0.05).There was no significant difference of the diagnostic sensitivity,accuracy nor ability of judging the degree of PFO-RLS between the latter 2 methods(all P>0.05),and the diagnostic consistency was extremely high(Kappa=0.852).The ability of TCD bubble test and cervicothoracic contrast-enhanced ultrasound for detecting small amount PFO-RLS were higher than that of TTE right cardiography(both P<0.05),and the diagnostic consistency of TCD bubble test with the latter 2 was medium and general(Kappa=0.429,0.311),respectively.Conclusion TCD bubble test had high sensitivity and accuracy for diagnosing PFO-RLS,but it was difficult to detect the location of RLS.The specificity of TTE right cardiography for diagnosing PFO-RLS was high,but the sensitivity and accuracy were not good,especially for small amount of PFO-RLS.Cervicothoracic contrast-enhanced ultrasound had high diagnostic specificity,sensitivity and accuracy,being able to detect small amount of PFO-RLS and localize RLS.
作者
张辉
曾令均
钟钧琳
张奥华
鲍健
殷珊珊
张艳玲
ZHANG Hui;ZENG Lingjun;ZHONG Junlin;ZHANG Aohua;BAO Jian;YIN Shanshan;ZHANG Yanling(Department of Ultrasound,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Neurology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《中国医学影像技术》
CSCD
北大核心
2021年第10期1471-1476,共6页
Chinese Journal of Medical Imaging Technology
基金
国家自然科学基金(81701713)。
