scholarly journals Detecting a patent foramen ovale by transcranial doppler sonography (tcd)

1996 ◽  
Vol XXVIII (3-4) ◽  
pp. 23-25
Author(s):  
М. Salaschek ◽  
R. Winkel
Keyword(s):  
Cerebral Ischemia ◽  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Doppler Sonography ◽  
Saline Solution ◽  
Transcranial Doppler Sonography ◽  
Unknown Origin ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Insignificant Difference

In patients with cerebral ischemia of unknown origin, paradoxical embolism must be considered as one of the possible causes, if there is an abnormal right-to- left shunt. The most likely site of transmission is a persisting patent foramen ovale (PFO), which is found in approximately 30% of adult persons in autopsy studies. Using transcranial Doppler sonography (TCD) and an agitated saline solution as an inexpensive and readily available contrast medium, probably all clinically important right-to-left shunts can be detected. In our department we examined 215 patients within the last 5 years, 30% of which had an abnormal right-to-left shunt with insignificant difference between 10 and 69 years of age.

scholarly journals Paradoxical emboli: Clinical importance of transcranial doppler for detection of patent foramen ovale

2010 ◽  
Vol 63 (7-8) ◽  
pp. 445-449
Author(s):  
Zeljko Zivanovic ◽  
Svetlana Ruzicka-Kaloci ◽  
Aleksandar Jesic ◽  
Biljana Radovanovic ◽  
Aleksandra Lucic-Prokin ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Doppler Sonography ◽  
Contrast Echocardiography ◽  
Cryptogenic Stroke ◽  
Transcranial Doppler Sonography ◽  
Foramen Ovale ◽  
Predictive Values ◽  
Bubble Test

A patent foramen ovale has been reported to be more frequently detected in cryptogenic stroke, with paradoxical embolism as the major pathogenetic mechanism. The standard procedure for the detection of a patent foramen ovale is transesophageal echo?cardiography. Transcranial Doppler sonography with bubble test is almost as reliable as transesophageal echocardiography. Seventeen patients with acute ischemic stroke and transient ischemic attacks hospitalized at the Department of Neurology in Novi Sad underwent examinations to detect a patent foramen ovale, which was found in 55.6% of patients with cryptogenic stroke. The average age of these patients was 30.6 years. Transcranial Doppler sonography showed 100% sensitivity and 100% specificity for the predicti?on of right-to-left shunts proven by transesophageal contrast echocardiography. Both positive and negative predictive values in our group of patients were 1. Transcranial Doppler with bubble test is a reliable method for the detection of a patent foramen ovale, with a high level of sensitivity and specificity which is comparable with transesophageal echocardiography. Moreover, it is cheaper and more comfortable than transesophageal echocardiography, and should be used routinely in neurological practice.

scholarly journals Comparison of Transthoracic Echocardiography, Transesophageal Echocardiography, and Transcranial Doppler in the Detection of Patent Foramen Ovale as the Etiology for Cryptogenic Stroke

2018 ◽  
Vol 35 (2) ◽  
pp. 127-133
Author(s):  
Madison B. Stafford ◽  
Jennifer E. Bagley ◽  
Dora DiGiacinto
Keyword(s):  
Transesophageal Echocardiography ◽  
Transcranial Doppler ◽  
Transthoracic Echocardiography ◽  
Gold Standard ◽  
Patent Foramen Ovale ◽  
Doppler Sonography ◽  
Cryptogenic Stroke ◽  
Transcranial Doppler Sonography ◽  
Young Patients ◽  
Foramen Ovale

The correlation between cryptogenic stroke and patent foramen ovale is high in young patients. Currently, transesophageal echocardiography is the gold standard for detection. However, it is invasive and limits Valsalva maneuvers. This article reviews the diagnostic accuracy of the three modalities: transthoracic echocardiography, transesophageal echocardiography, and transcranial Doppler. The results suggest that transcranial Doppler sonography is an accurate, easily accessible procedure for detecting patent foramen ovale and should be considered an excellent alternative to transthoracic or transesophageal echocardiography. Transesophageal echocardiography is still necessary for patients who require treatment. The combination of transcranial Doppler and transesophageal echocardiography provides the highest level of information regarding the complete diagnosis of patent foramen ovales.

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.

Validation of Transcranial Doppler Sonography in the Assessment of Patent Foramen Ovale

1995 ◽  
Vol 5 (3) ◽  
pp. 194-198 ◽  
Author(s):  
G. Paolo Anzola ◽  
E. Renaldini ◽  
M. Magoni ◽  
A. Costa ◽  
M. Cobelli ◽  
...  
Keyword(s):  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Foramen Ovale

Abstract 204: Transcranial Doppler Versus Transthoracic Echocardiography for the Detection of Patent Foramen Ovale in Patients With Cryptogenic Cerebral Ischemia: A Systematic Review and Diagnostic Test Accuracy Meta-analysis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Aristeidis H Katsanos ◽  
Theodora Psaltopoulou ◽  
Theodoros Sergentanis ◽  
Alexandra Frogoudaki ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Sensitivity And Specificity ◽  
Transcranial Doppler ◽  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Diagnostic Yield ◽  
Positive Likelihood Ratio ◽  
Receiver Operating Curve ◽  
Test Accuracy ◽  
Foramen Ovale

Background & Purpose: Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic cerebral ischemia has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach. Methods: We performed a systematic literature review according to PRISMA guidelines to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD or both compared to the gold standard of TEE. Results: Our literature search identified 35 eligible studies including 3067 patients. The summary sensitivity and specificity for TCD was 96.1% (95% confidence interval: 93.0%-97.8%) and 92.4% (95%CI: 85.5%-96.1%), whereas the respective measures for TTE were 45.1% (95%CI: 30.8-60.3%) and 99.6% (95%CI: 96.5-99.9%). The summary diagnostic odds ratio (DOR) for TCD (DOR=297.97, 95%CI: 131.18-676.83) and TTE (DOR=193.44, 95%CI: 30.38-1231.67) did not significantly differ (z-value=0.418, p=0.676). TTE was superior in terms of higher positive likelihood ratio values (LR+= 106.61, 95%CI: 15.09-753.30 for TTE vs. LR+=12.62, 95%CI: 6.52-24.43 for TCD; p=0.043), while TCD yielded lower negative positive likelihood values (LR- = 0.04, 95%CI: 0.02-0.08) compared to TTE (LR- =0.55, 95%CI: 0.42-0.72; p<0.001). Finally, the area under the summary receiver operating curve was significantly greater (p<0.001) in TCD (AUC=0.98, 95%CI: 0.97-0.99; Figure A) compared to TTE studies (AUC=0.86, 95%CI: 0.82-0.89; Figure B). Conclusions: TCD is more sensitive but less specific compared to TTE for the detection of PFO in patients with cryptogenic cerebral ischemia. The overall diagnostic yield of TCD appears to outweigh that of TTE.

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.

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