心脏磁共振联合经颅多普勒发泡实验诊断卵圆孔未闭的研究

Study of Cardiac Magnetic Resonance Combined with Contrast-Enhanced Transcranial Doppler in the Diagnosis of Pa-tent Foramen Ovale

摘要: 目的：探讨颅多普勒发泡实验(contrast-enhanced transcranial Doppler, c-TCD)联合心脏磁共振(cardiac magnetic resonance, CMR)在卵圆孔未闭(patent foramen ovale, PFO)诊断中的价值。方法：选取2019年5月~2010年05月于青岛大学附属医院神经内科住院治疗的患者中c-TCD筛选右向左分流(right to left shunt, RLS)阳性的98例患者。所有患者完善CMR及经胸超声心动图(transthoracic echocardiography, TTE)检查。比较98例RLS阳性的患者中CMR及TTE对PFO的检出率，根据RLS的分流程度不同，将RLS阳性的患者分为小分流组(≤25个微栓子信号)和大分流组(>25个微栓子信号，形成“帘状”或“淋浴”)，比较CMR及TTE在小分流组和大分流组对PFO的检出率。结果：98例RLS阳性患者中CMR检出PFO 93例，TTE检出PFO 55例，CMR对PFO的检出率高于TTE (94.9% vs. 56.1%, P = 0.000)；44例小分流患者中，CMR检出PFO 39例，TTE检出PFO 8例，CMR对PFO的检出率高于TTE (88.6% vs. 18.2%, P = 0.000)；54例大分流患者中，CMR检出PFO 54例，TTE检出PFO 47例，CMR对PFO的检出率高于TTE (100% vs. 87.0%, P = 0.000)。结论：c-TCD联合CMR对PFO的检出率显著高于c-TCD联合TTE，在临床工作中对不适合行经食道超声(transesophageal echocardiography, TEE)的患者可以推荐c-TCD联合CMR诊断是否存在PFO。

Abstract: Objective: To explore the value of CMR combined with c-TCD in the diagnosis of PFO. Methods: A to-tal of 98 patients attending the stroke unit at the Affiliated Hospital of Qingdao University from May 2019 to May 2010, who with right to left shunt (RLS) confirmed by C-TCD were selected. CMR and TTE were completed in all participants. The rate PFO evaluated with CMR and TTE respectively in the 98 RLS positive patients were compared. According to the degree of RLS , the RLS positive group was further divided into mild shunt group (≤25 microemboli signals) and large shunt group (>25 microemboli signals, forming a “curtain” or “shower”). The rates of PFO evaluated with CMR and TTE in mild shunt group and large shunt group were also compared. Results: Among the 98 RLS positive patients, 93 PFO were detected by CMR and 55 PFO were detected by TTE. The rate of PFO examined by CMR was higher than that by TTE (94.9% vs. 56.1%, P = 0.000). Among the 44 patients in mild shunt group, 39 PFO were detected by CMR and 8 PFO were detected by TTE. The rate of PFO de-tected by CMR was higher than that by TTE (88.6% vs. 18.2%, P = 0.000). Among the 54 patients with large shunt group, PFO was detected in 54 by CMR and 47 by TTE, and the rate of PFO detected with CMR was higher than that with TTE (100% vs. 87.0%, P = 0.000). Conclusion: CMR combined with c-TCD has higher positive rates of PFO than TTE combined with c-TCD. PFO could be screening out with CMR combined with c-TCD when TEE was not suitable for patients in clinic practice.