A comparison of transesophageal echocardiography and transcranial Doppler sonography with contrast medium for detection of patent foramen ovale.

Jauß, M.; Kaps, Manfred; Keberle, Marc; Haberbosch, Werner; Dorndorf, W.

doi:10.1161/01.str.25.6.1265

Cited by 139 publications

(112 citation statements)

References 15 publications

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“…With contrast TT echocardiography, 4 TE echocardiography, 32,33,51 or TCD 25,52 or during cardiac catheterization, 53 patients with presumed paradoxical embolization appear to have larger PFOs compared with those in control groups. In the recent PFO in Cryptogenic Stroke Study (PICSS), it also has been shown that large PFOs were significantly more prevalent among cryptogenic stroke patients compared with those with known cause of stroke.…”

Section: Factors Associated With Paradoxical Embolization Atrial Anatomymentioning

confidence: 90%

“…21,22 Several studies performed contrast TT, TE, and TCD imaging in the same patient group to compare the sensitivity of the techniques (Table 2). [23][24][25][26][27][28][29][30] The TE contrast study is the most sensitive diagnostic test available for detecting a PFO, followed by TCD and TT contrast studies (PϽ0.001 for TE versus TT and for TCD versus TT contrast studies).…”

Section: Transcranial Doppler In Pfo Detectionmentioning

confidence: 99%

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Patent Foramen Ovale and Stroke

2005

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Section: Factors Associated With Paradoxical Embolization Atrial Anatomymentioning

confidence: 90%

Section: Transcranial Doppler In Pfo Detectionmentioning

confidence: 99%

Patent Foramen Ovale and Stroke

2005

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“…S transcranial Doppler sonography (ce-TCDS) is a reliable tool for detection of RLS. [7][8][9][10][11] Depending on the method and UCA used for RLS detection, the sensitivity and specificity of the ce-TCDS method compared with the reference standard have been estimated to be between 90% and 100%. 6,12,13 With respect to the comfort of the patient, ce-TCDS is preferred over TEE as a screening tool.…”

mentioning

confidence: 99%

Detection of Cardiac Right-to-Left Shunts by Contrast-Enhanced Harmonic Carotid Duplex Sonography

Draganski

Blersch²,

Holmer³

et al. 2005

Journal of Ultrasound in Medicine

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Objective Paradoxical embolization by cardiac right‐to‐left shunts (RLS) is increasingly recognized as an important factor for embolic stroke. Contrast‐enhanced transcranial Doppler sonography (ce‐TCDS) is an established diagnostic tool for RLS detection but is frequently limited because of an inadequate temporal acoustic bone window. The purpose of this study was to determine whether extracranial sonography (ECS) using harmonic frequencies improves detection of RLS. Methods Extracranial color duplex sonography using harmonic frequencies enables visualization of even single ultrasound contrast agent microbubbles because of oscillation. Patients with stroke and positive RLS findings on transesophageal echocardiography underwent a simultaneous extracranial and transcranial sonographic examination of the proximal common carotid artery (CCA) and middle cerebral artery (MCA) on the same side. A Valsalva strain was performed for 10 seconds after intravenous bolus injection of a galactose‐based nontranspulmonary contrast agent. The B‐mode frame sequences of the transverse plane of the CCA obtained by harmonic ECS and the ce‐TCDS recordings of high‐intensity transient signals from the MCA were analyzed offline. Results In all patients with RLS, the shunts could be identified by harmonic ECS. A close correlation could be seen between the count of visualized microbubbles in the CCA and the number of high‐intensity transient signals detected on ce‐TCDS in the ipsilateral MCA. Conclusions The results of this study indicate that contrast‐enhanced ultrasound harmonic imaging of the CCA using a Valsalva strain might be an optional screening tool for detection of cardiac RLS in patients with insufficient acoustic bone windows.

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“…(1) The appropriate timing of the VM in relation to the injection of the contrast medium is under debate. The injection of the contrast agent was performed before, 4,[11][12][13][14][15][16][17][18] during, 15,17,19 or after the VM. 15,20 In those studies in which the VM was performed after injection, the time delay between injection and VM was frequently not clearly specified in relation to the start or the end of injection.…”

mentioning

confidence: 99%

“…22 Furthermore, the question of whether the use of a diagnostic time window for MES appearance increases the specificity of the test without necessarily decreasing sensitivity is not yet resolved. 14,23,24 Time windows proposed between the intravenous injection of the contrast medium and its appearance in the MCAs are 6 heartbeats, 20 10 seconds, 20,21 15 seconds, 13 20 seconds, 24 22 seconds, 15 and 25 seconds. 11,14 A recent study described the necessity of including MES at least 20 to 25 seconds after the start of injection to achieve a high sensitivity; it may also be possible that no time window is necessary.…”

mentioning

confidence: 99%

Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Droste

Silling

Stypmann

et al. 2000

Stroke

107

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Background and Purpose-Cardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of contrast agents and a Valsalva maneuver (VM) as provocation procedure. Currently, data on the appropriate timing of the VM, the use of a diagnostic time window, and a threshold in contrast agent microbubbles detected are insufficient. Methods-Fifty-eight patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with injections of 10 mL of the commercial galactose-based contrast agent Echovist was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 2 seconds after the beginning of contrast injection, (3) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, (4) VM for 5 seconds starting 8 seconds after the beginning of contrast injection, and (5) repetitive short VMs in between 2 and 13 seconds after the beginning of contrast injection. In addition to the single tests, we also tested the sensitivity and specificity of combined results of the tests with VM. Results-In 21 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt positive). Twenty-one patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 16 patients were only positive on at least 1 TCD investigation but negative during TEE. Test 3 was the most appropriate test when combined with the results of 1 of the other tests with VM. The highest sensitivities were achieved with a diagnostic time window of 40 seconds and when the presence of a single microbubble was sufficient for the diagnosis of a shunt. Conclusions-TCD performed twice with 2 provocation maneuvers with Echovist is a sensitive method to identify TEE-proven cardiac right-to-left shunts. The VM should be performed for 5 seconds starting at 5 seconds after the beginning of contrast injection.

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A comparison of transesophageal echocardiography and transcranial Doppler sonography with contrast medium for detection of patent foramen ovale.

Cited by 139 publications

References 15 publications

Patent Foramen Ovale and Stroke

Patent Foramen Ovale and Stroke

Detection of Cardiac Right-to-Left Shunts by Contrast-Enhanced Harmonic Carotid Duplex Sonography

Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

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