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.

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.

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.

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

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.

Prevalence of Patent Foramen Ovale in Migraine Patients with and Without Aura Compared with Stroke Patients. A Transcranial Doppler Study

Cephalalgia ◽  
2006 ◽  
Vol 26 (8) ◽  
pp. 934-939 ◽  
Author(s):  
FJ Carod-Artal ◽  
L da Silveira Ribeiro ◽  
H Braga ◽  
W Kummer ◽  
HM Mesquita ◽  
...  
Keyword(s):  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Transcranial Doppler Sonography ◽  
Young Patients ◽  
Data Bank ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Doppler Study ◽  
The Difference

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7± in migraine with aura (MA) patients, 33.7± in migraine without aura (MoA) patients, 33.8± in young stroke patients and 20.5± in elderly stroke patients ( P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1± and 25± ( P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.

scholarly journals Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ekkehard Kunze ◽  
Mirko Pham ◽  
Furat Raslan ◽  
Christian Stetter ◽  
Jin-Yul Lee ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Negative Predictive Value ◽  
Neurological Examination ◽  
Transcranial Doppler ◽  
Predictive Value ◽  
Doppler Sonography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Transcranial Doppler Sonography ◽  
Perfusion Ct ◽  
Angiographic Vasospasm

Background. If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF) and protect the brain from ischemic damage. This study was conceived to compare the diagnostic accuracy of detailed neurological examination, Transcranial Doppler Sonography (TCD), and Perfusion-CT (PCT) to detect angiographic vasospasm.Methods. The sensitivity, specificity, positive and negative predictive values of delayed ischemic neurological deterioration (DIND), pathological findings on PCT-maps, and accelerations of the mean flow velocity (MVF) were calculated.Results. The accuracy of DIND to predict angiographic vasospasm was 0.88. An acceleration of MFV in TCD (>140 cm/s) had an accuracy of 0.64, positive PCT-findings of 0.69 with a higher sensitivity, and negative predictive value than TCD.Interpretation. Neurological assessment at close intervals is the most sensitive and specific parameter for cerebral vasospasm. PCT has a higher accuracy, sensitivity and negative predictive value than TCD. If detailed neurological evaluation is possible, it should be the leading parameter in the management and treatment decisions. If patients are not amenable to detailed neurological examination, PCT at regular intervals is a helpful tool to diagnose secondary vasospasm after aneurysmal SAH.

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