经颅多普勒发泡试验、经胸超声心动图右心造影及颈胸联合超声造影诊断卵圆孔未闭右向左分流

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。

Transcranial Doppler bubble test, transthoracic echocardiography right cardiography and cervicothoracic contrast-enhanced ultrasound for diagnosing right-to-left shunt of patent foramen ovale

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.