scholarly journals Transcranial Doppler for patent foramen ovale screening: is there a good correlation with transesophageal echocardiography?

2008 ◽  
Vol 66 (4) ◽  
pp. 785-789 ◽  
Author(s):  
Marcos Christiano Lange ◽  
Viviane Flumignan Zétola ◽  
Admar Moraes de Souza ◽  
Élcio Juliato Piovesan ◽  
Juliano André Muzzio ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Transcranial Doppler ◽  
Predictive Value ◽  
Screening Test ◽  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Negative Results ◽  
Contrast Enhanced ◽  
Group 2 ◽  
Group 1

Right-to-left shunt (RLS) can be identified by contrast-enhanced transcranial Doppler (cTCD) in patent foramen ovale (PFO) patients. AIM: To evaluate cTCD for PFO screening comparing it to cTEE. METHOD: 45 previous cTCD performed for PFO diagnosis and correlated its findings with cTEE. Patients were submitted to a cTCD standardized technique and were divided in two groups according to RLS: Group 1, patients with a positive RLS and Group 2 when RLS was negative. RESULTS: 29 (65%) patients were included in group 1 and 16 (35%) in group 2. PFO confirmation by cTEE was performed in 28 (62%) patients. cTCD had a 92.85% sensitivity, 82.35% specificity, 89.65% positive predictive value and 87.5% negative predictive value when compared to cTEE for PFO diagnosis. CONCLUSION: Standardized technique cTCD allows for RLS visualization in PFO patients with a good correlation with cTEE and can be used as a screening test before cTEE.

scholarly journals Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

2012 ◽  
Vol 70 (8) ◽  
pp. 578-582 ◽  
Author(s):  
Laura Nicoleti Zamproni ◽  
Viviane Flumignan Zétola ◽  
Marcos Christiano Lange
Keyword(s):  
Antiphospholipid Syndrome ◽  
Transcranial Doppler ◽  
High Intensity ◽  
Patent Foramen Ovale ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Stroke Group ◽  
History Of

OBJECTIVE: Patent foramen ovale is associated with paradoxical embolism (PE) and stroke. Hypercoagulable states, such as antiphospholipid syndrome (APS), can exacerbate PE by increasing clot formation. The aim of this study was to verify whether patients with APS and stroke present a right-to-left shunt (RLS) with greater frequency than patients with APS but without stroke. METHODS: Fifty-three patients with APS were tested for RLS using contrast-enhanced transcranial Doppler (cTCD): 23 patients had a history of stroke (Stroke Group) and 30 had no history of stroke (No-stroke Group). RESULTS: cTCD was positive in 15 patients (65%) from the Stroke Group and in 16 patients (53%) in the No-stroke Group (p=0.56). The proportion of patients with a small RLS (<10 high-intensity transient sign or HITS) and a large RLS (>10 HITS) was similar between the groups without significant difference. CONCLUSIONS: Our data do not support the theory that paradoxical embolism may play an important role in stroke in APS patients.

scholarly journals Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

2019 ◽  
Vol 67 (2) ◽  
pp. 93-102
Author(s):  
Krzysztof Dziewiatowski ◽  
Piotr Siermontowski
Keyword(s):  
Left Atrium ◽  
Sensitivity And Specificity ◽  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Adult Population ◽  
Venous Blood ◽  
Arterial System ◽  
Foramen Ovale ◽  
Contrast Enhanced

Abstract Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.

scholarly journals Morphometric Features of Patent Foramen Ovale as a Risk Factor of Cerebrovascular Accidents: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 49 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Mateusz K. Hołda ◽  
Mateusz Koziej
Keyword(s):  
Systematic Review ◽  
Cerebrovascular Accident ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Foramen Ovale ◽  
Cerebrovascular Accidents ◽  
Morphometric Features ◽  
Group 2 ◽  
Group 1

Introduction: It is still disputable whether specific morphometric features of the patent foramen ovale (PFO) may stratify patients by the related probability that a discovered PFO is incidental or stroke related. Objective: We aimed to determine whether certain morphometrical characteristics of PFO are associated with an increased risk of cerebrovascular accidents, using a meta-analytical approach. Methods: We performed a systematic review of electronic databases for studies that compared morphometric parameters of PFO assessed by transesophageal echocardiography (TEE) in subjects with cryptogenic cerebrovascular accidents (Group 1) and control (Group 2). Data were extracted and pooled into a meta-analysis. Results: A total of 895 patients with PFO were reported (Group 1: 493, Group 2: 402). No difference was found in the PFO channel length (Group 1: 10.8 [8.6–12.9] mm vs. Group 2: 10.4 [9.1–11.7] mm), as well as in PFO height measured at rest (Group 1: 2.4 [1.5–3.3] mm vs. Group 2: 1.8 [1.4–2.2] mm). The PFO height measured during a Valsalva maneuver was larger in Group 1 (3.5 [2.8–4.1] mm) than in Group 2 (1.7 [1.2–2.2] mm). Also, the septal excursion distance was found to be larger in Group 1 (6.4 [5.1–7.8] mm) than in Group 2 (3.1 [1.8–4.4] mm). The risk of cerebrovascular accident was higher in patients with PFO and concomitant septal aneurysm (OR 4.00; 95% CI 2.63–6.09; p < 0.001) and with large right-to-left shunt PFO (OR 3.81; 95% CI 2.21–6.55; p < 0.001), no such relationship was found for the presence of a Eustachian valve or Chiari’s network (OR 1.90; 95% CI 0.90–4.05; p = 0.094). Conclusions: The TEE may help in identifying PFO that are of high risk of cerebrovascular accident. Greater PFO height during a Valsalva maneuver, larger septal excursion distance, concomitant atrial septal aneurysm, and large right-to-left shunt are associated with stroke-related PFOs.

scholarly journals Shear wave elastography: Can it be a new radiologic approach for the diagnosis of erectile dysfunction?

Ultrasound ◽  
2017 ◽  
Vol 25 (3) ◽  
pp. 150-155 ◽  
Author(s):  
Rustu Turkay ◽  
Ercan Inci ◽  
Mustafa Gurkan Yenice ◽  
Volkan Tugcu
Keyword(s):  
Erectile Dysfunction ◽  
Positive Predictive Value ◽  
Shear Wave ◽  
Predictive Value ◽  
Corpus Cavernosum ◽  
Shear Wave Elastography ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Introduction Erectile dysfunction (ED) is a common health problem among males, and radiology has limited use in its diagnosis and treatment. Shear wave elastography (SWE) is a new sonographic technique. In this study, we examined the significance of SWE in the diagnosis of ED. Methods The study included a total number of 70 participants. The mean age of the participants was 54.14 ± 8.03 years (range: 39 and 71 years old). We composed two groups. Group 1 had 35 patients who presented to the urology clinic in our hospital complaining of ED, and had a score of 17 or lower from the International Index of Erectile Function (IIEF) questionnaire. Group 2 consisted of 35 healthy volunteers who did not have ED. SWE measurements were performed from corpus cavernosum penis in both groups, and the results were noted. Differences between the groups were evaluated statistically. Results The difference between the mean SWE measurements of two groups (Group 1: 20.94 ± 6.23 kPa and group 2: 24.63 ± 7.58 kPa) was found to be statistically significant ( p = 0.027; p < 0.05). For a cut-off value of 17.1 kPa, the SWE method has specificity, sensitivity, positive predictive value, and negative predictive value regarding diagnosis of ED as 94.29%, 34.29%, 85.71%, and 58.93%, respectively. The mean age of the groups did not show a statistically significant difference ( p = 0.287; p > 0.05). Conclusions Due to its high specificity and positive predictive value, SWE can offer useful data in the radiologic evaluation of ED cases.

scholarly journals Right to left shunting detection by contrast-enhanced transcranial color-coded duplex among patients with cryptogenic stroke

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Samia Ashour Mohamed ◽  
Mohamed Ayman Saleh ◽  
Hala Mahmoud ELKhawas ◽  
Eman Saleh ElHadidi ◽  
Ahmed ElSadek ◽  
...  
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Patent Foramen Ovale ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Contrast Enhanced ◽  
Ischemic Attack ◽  
Sensitive Method

Abstract Background Contrast-enhanced transcranial duplex (c-TCD) might be more sensitive than transesophageal echo (TEE) for detection of right to left shunting (RLS), which misses some cases with substantial RLS and might be valuable for prediction of recurrent stroke or transient ischemic attack in patients with PFO. Our aim is to detect sensitivity and specificity of contrast-enhanced TCD in detection of RLS among stroke patients with patent foramen ovale (PFO) in comparison to TEE. Methods TEE and contrast-enhanced TCD for cryptogenic stroke patients with PFO were done to detect right to left shunting. Results On testing characteristics of TCD in detecting RLS compared to the gold standard of TEE, TCD sensitivity was 85.7%, specificity was 100%, negative predictive value was 96.55%, and positive predictive value was 100%. Conclusion We concluded that PFO is considered an important hidden etiology for ischemic stroke. Contrast-enhanced TCD is considered sensitive method for detection of right to left shunting among PFO patients.

scholarly journals Day-Case Patent Foramen Ovale Closure Under Transthoracic Echocardiography and Fluoroscopic Guidance: A Safe and Cost-Effective Approach as Compared to Conventional Hospitalization

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Godart F ◽  
◽  
Baudelet J B ◽  
Chatillon-Domanski O ◽  
Polge A S ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Day Case ◽  
Positive Balance ◽  
Group 2 ◽  
The Impact ◽  
Pfo Closure ◽  
Group 1

Background: Transcatheter Patent Foramen Ovale (PFO) is recommended as a therapy in secondary prevention of cryptogenic stroke. The aim of this study was to report one-year French single-center experience in PFO closure under sole Transthoracic Echocardiography (TTE) and fluoroscopy guidance performed as a day-case procedure versus a 3-day hospitalization. Methods: In 2018, all consecutive patients undergoing PFO closure for stroke were retrospectively included: 108 patients as a day-case procedure (group 1) versus 20 patients performed under a 3-day hospitalization (group 2). A comparison was performed between Occlutech and Amplatzer PFO devices and the impact on hospitalization costs was studied. Results: Occluders included Occlutech (n=81), Amplatzer (n=43), Lifetech (n=2) and PFM (n=2) PFO devices. Implantation succeeded in all. In-group 1, hospital discharge was delayed in only 3 cases. At one-month, 5 patients had Atrial Fibrillation (AF) and 91 patients (84%) had no residual shunt. In-group 2, hospital discharge was delayed in 4 patients. At one month, 1 patient had AF and no shunt was observed in 80%. In the comparative study, no significant statistical difference could be observed between Amplatzer and Occlutech devices. The one-day strategy leaded to a positive balance of 1825 euros per procedure in 2018, with a difference of 3785 euros with group 2. Conclusion: Our experience suggests that day-case PFO closure under fluoroscopy and TTE guidance is safe and effective in the majority of patients leading to a cost reduction and no increased risk of embolization.

Value of Cardiac Cine MRI in Comparison to Contrast Transcranial Doppler Sonography for Patent Foramen Ovale Assessment in Patients with Cerebral Disorders

2021 ◽  
Author(s):  
Zhiming Li ◽  
Shunli Liu ◽  
Tingfei Yan ◽  
Yabin Hu ◽  
Chuanyu Zhang ◽  
...  
Keyword(s):  
Transcranial Doppler ◽  
Predictive Value ◽  
Patent Foramen Ovale ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Cine Mri ◽  
Foramen Ovale ◽  
Color Coding ◽  
Cardiac Cine ◽  
Pseudo Color

Abstract Purpose: To investigate the clinical feasibility of diagnosing and classifying patent foramen ovale (PFO) in patients with cerebral disorders by cardiac cine MRI (CCMRI) without contrast.Materials and Methods: Forty-four patients (24 males and 20 females; mean age, 41.3 years; range, 21–64 years) with cerebral disorders underwent contrast transcranial Doppler sonography (cTCD) and non-enhanced CCMRI examinations between October 2019 and March 2020. CCMRI was performed with a 3.0T magnetic resonance (MR) scanner using the OBL FIESTA CINE 4CH sequence. The scanning direction was perpendicular to the interatrial septum (IAS). The obtained MR images were analyzed by AW station 4.4. Pseudo-color coding was performed based on the different phases. The blood shunt condition was observed and recorded, noting the PFO length and width and whether it was complicated by IAS aneurysm or secondary septum thickening.Results: Thirty-nine of the 44 patients with cerebral disorders were confirmed to have right-to-left shunt by cTCD, and 37 of them were diagnosed with PFO by CCMRI. Two of the five remaining patients were also diagnosed with PFO by CCMRI. Compared with cTCD as a standard, CCMRI assessment resulted in the following: sensitivity, 94.9%; specificity, 60.0%; accuracy, 90.9%; positive predictive value, 94.9%; negative predictive value, 60.0%; area under the curve, 0.774. Using pseudo-color coding, a right-to-left color jet was observed in 34 patients, and a two-way shunt was found in five. IAS aneurysm and secondary septum thickening were found in five and three patients (11.4% and 6.8%), respectively. The maximum PFO diameters ranged from 1.7 to 16.8 mm, and the mean diameter was 5.4 ± 3.4 mm.Conclusion: The noninvasive CCMRI without contrast proved an excellent method for PFO identification, evaluation, and classification, with high sensibility (92.85%) and concordance (90.9%) compared to cTCD.

Serum Inhibin B and Follicle-Stimulating Hormone Levels as Tools in the Evaluation of Infertile Men: Significance of Adequate Reference Values from Proven Fertile Men

2004 ◽  
Vol 89 (6) ◽  
pp. 2873-2879 ◽  
Author(s):  
Anna-Maria Andersson ◽  
Jørgen H. Petersen ◽  
Niels Jørgensen ◽  
Tina K. Jensen ◽  
Niels E. Skakkebæk
Keyword(s):  
General Population ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Reference Group ◽  
Serum Markers ◽  
Inhibin B ◽  
Control Group ◽  
Infertile Men ◽  
Group 2 ◽  
Group 1

Abstract Inhibin B and FSH levels in 289 idiopathic infertile men were compared with reference materials consisting of 303 proven fertile men (reference group 1) and 307 healthy men from the general population with unknown fertility status (reference group 2). The diagnostic power of these two serum markers of spermatogenesis was evaluated by the use of receiver operating characteristic plot analysis, and an example of how both markers can be used simultaneously in a bivariate reference chart is presented. Inhibin B levels were significantly lower and FSH levels were significantly higher in the infertile men, compared with either reference group, but with significant overlap, especially with reference group 2. Nevertheless, approximately 50% of the infertile men had an inhibin B or FSH, respectively, below the 2.5 percentile or above the 97.5 percentile of reference group 1, whereas only approximately 25% of the infertile men had an inhibin B or FSH, respectively, below the 2.5 percentile or above the 97.5 percentile of reference group 2. Fourteen and 11% of reference group 2 had an inhibin B or FSH, respectively, below the 2.5 percentile or above the 97.5 percentile of reference group 1, suggesting that a significant number of individuals from the general population with unknown fertility but otherwise healthy may actually be subfertile. In conclusion, 1) proven fertile men constitute the most appropriate reference group in the evaluation of the FSH-inhibin B axis; the sensitivity of these markers to identify infertility increased by approximately 20% when fertile men rather than men from the general population were used as control group; 2) FSH alone had a slightly higher positive predictive value than inhibin B alone, but the positive predictive value were highest when both markers of spermatogenesis were used in an inhibin B/FSH ratio; and 3) a bivariate reference chart is a valuable objective tool in the simultaneous evaluation of FSH and inhibin B as two interrelated markers.

scholarly journals Is the patent foramen ovale closure the best option?

2012 ◽  
Vol 70 (12) ◽  
pp. 934-938
Author(s):  
Viviane Flumignan Zetola ◽  
Melissa Castello Branco e Silva ◽  
Marcos Christiano Lange ◽  
Juliano Andre Muzzio ◽  
Edison Matos Novak ◽  
...  
Keyword(s):  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Foramen Ovale ◽  
Contrast Enhanced ◽  
Number Of Patients ◽  
Study Results ◽  
Before And After ◽  
One Year ◽  
Pfo Closure

Patent foramen ovale (PFO) closure is indicated in some cases to protect patients against embolic events. The aim of this study was to certify that the method of PFO closure to prevent microemboli (MES) is reliable, using contrast enhanced transcranial Doppler (cTCD) as a diagnostic and follow-up tool. METHODS: cTCD was performed before and after PFO closure in 20 patients. Results obtained a minimum of 12 months after the procedure were analyzed in this study. RESULTS: After the procedure, 14 patients (82%) showed no microemboli in cTCD at rest, but after provocative Valsalva maneuver (VM) microembolic phenomenon were still detected in 14 (70%): 7 (35%) <10 MES, 3 (15%) 10-20 MES and 4 (20%) had more than 20 MES ("curtain"). Only six of the total patients presented no MES in both resting and VM. CONCLUSION: These results showed a large percentage of patients with MES detection in a bubble study with transcranial Doppler more than one year after the procedure of PFO closure, showing right-to-left residual shunting. Despite the small number of patients, this study provides important data about this therapeutic decision.

Abstract WP214: Transcranial Color Coded Sonography versus Transcranial Doppler for the Detection of Right-to-left Shunt and Patent Foramen Ovale in Young Patients With Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Milena C Libardi ◽  
Millene R Camilo ◽  
Soraia R Fabio ◽  
Rui Kleber V Martins Filho ◽  
Letícia J Rocha ◽  
...  
Keyword(s):  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Young Patients ◽  
Positive Likelihood Ratio ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Contrast Enhanced ◽  
Hospital Patients ◽  
Bubble Test ◽  
Kappa Agreement

Introduction: Patent Foramen Ovale (PFO) is the most common right-to-left shunt (RLS) and is often found in young patients with stroke related to paradoxical embolism. Contrast-Enhanced Transesophageal Echocardiography (TEE) is considered a gold standard to visualize PFO. Transcranial Doppler (TCD) with bubble test is often used to detect RLS with good correlation to TEE for the diagnostic of PFO. More recently, Transcranial Color Coded Sonography (TCCS) which included B-mode and color coded imaging has overcome TCD in many clinical applications but the accuracy of TCCS for detection of RLS and PFO has not been systematically evaluated. Hypothesis: To determine if the TCCS is an accurate tool to identify both PFO and RLS. Methods: We investigate 106 patients with ischemic stroke under 55 years-old admitted from 2012 to 2014 in a tertiary academic hospital. Patients were evaluated with TEE, TCD and TCCS, and all exams included a saline bubble test. The examiners were blinded for the other tests results. Kappa agreement was calculated inter-examiners for TCCS and TCD. Accuracy of TCCS was calculated in comparison to TEE. Results: We detected a RLS in 54 (50.9%) patients (age mean 43.9 ± 8.2) with kappa agreement 0.92 (95%CI 0.78-1.0) when performed TCCS and TCD. TEE and TCSS were positive in 23/98 (23.4%) and TEE did not reveal contrast in 20/98 (20.4%). In 30 (28.3%) patients only TEE revealed a PFO. TCSS had a sensitivity of 88.4% (95%CI 0.68-0.97), specificity of 72.2% (95%CI 0.60-0.81) and positive likelihood ratio of 3.18 (2.14-4.73) of the diagnosis of PFO. Conclusion: TCCS and TCD had an excellent agreement. TCCS has a good accuracy for the detection of PFO and RLS in young patients with stroke.

Sign in / Sign up

Export Citation Format

Share Document