Document Detail

Contrast-enhanced transcranial Doppler ultrasound for diagnosis of patent foramen ovale.
MedLine Citation:
PMID:  17290139     Owner:  NLM     Status:  MEDLINE    
The suspected cause of clinical manifestations of patent foramen ovale (PFO) is a transient or a permanent right-to-left shunt (RLS). Contrast-enhanced transcranial Doppler ultrasound (c-TCD) is a reliable alternative to transesophageal echocardiography (TEE) for diagnosis of PFO, and enables also the detection of extracardiac RLS. The air-containing echo contrast agents are injected intravenously and do not pass the pulmonary circulation. In the presence of RLS, the contrast agents bypass the pulmonary circulation and cause microembolic signals (MES) in the basal cerebral arteries, which are detected by TCD. The two main echo contrast agents in use are agitated saline and D-galactose microparticle solutions. At least one middle cerebral artery (MCA) is insonated, and the ultrasound probe is fixed with a headframe. The monitored Doppler spectra are stored for offline analysis (e.g., videotape) of the time of occurrence and number of MES, which are used to assess the size and functional relevance of the RLS. The examination is more sensitive, if both MCAs are investigated. In the case of negative testing, the examination is repeated using the Valsalva maneuver. Compared to TEE, c-TCD is more comfortable for the patient, enables an easier assessment of the size and functional relevance of the RLS, and allows also the detection of extracardiac RLS. However, c-TCD cannot localize the site of the RLS. Therefore, TEE and TCD are complementary methods and should be applied jointly in order to increase the diagnostic accuracy for detecting PFO and other types of RLS.
Krassen Nedeltchev; Heinrich P Mattle
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Frontiers of neurology and neuroscience     Volume:  21     ISSN:  1660-4431     ISO Abbreviation:  -     Publication Date:  2006  
Date Detail:
Created Date:  2007-02-09     Completed Date:  2007-05-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101274949     Medline TA:  Front Neurol Neurosci     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  206-15     Citation Subset:  IM    
Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland.
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MeSH Terms
Brain Ischemia / etiology,  prevention & control,  ultrasonography
Cerebral Arteries / pathology,  physiopathology,  ultrasonography*
Cerebrovascular Circulation / physiology
Contrast Media / standards*
Heart Septal Defects, Atrial / complications,  physiopathology,  ultrasonography
Intracranial Embolism and Thrombosis / etiology,  physiopathology,  ultrasonography*
Regional Blood Flow / physiology
Stroke / etiology,  prevention & control,  ultrasonography
Ultrasonography, Doppler, Transcranial / methods*,  standards,  trends
Reg. No./Substance:
0/Contrast Media

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