経頭蓋カラードプラ (TC-CFI) による心内右左シャントの診断-循環器疾患群, 虚血性脳血管障害群, 眼虚血群間の比較検討-

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Background: Intracardiac right-to-left shunt (RLS) can be diagnosed by transcranial color-flow imaging (TC-CFI) by detecting high intensity transient signals (HITS) after injecting patients with intravenous contrast medium (CM) . The reliability of this method was evaluated and compared in patients with (A) heart disease, (B) Ischemic stroke and (C) ocular Ischemic syndrome. Subjects and Methods: Ninety-four patients (M: 59, F: 35; mean age 64±13 years) were examined. The number of patients in each group was: 38 in group A; 43 in group B; and 13 in group C. In the TC-CFI study, the number of HITS was determined at the middle cerebral artery or basilar artery after injecting CM under the Valsalva maneuver. In the transesophageal echocardiography (TEE) study, the number of microbubbles from the right to the left atrium was counted. Results: In the TEE study, RLS was observed in 31 patients (33%) . In the TC-CFI study, the overall sensitivity was 37% and specificity 100%. The sensitivity and specificity for each subgroup were: 9% and 100%, respectively, for group A; 56% and 100% for group B; and 17% and 100% for group C. Conclusions: The sensitivity of TC-CFI for detecting RLS was higher in the group of patients with ischemic stroke. RLS detected by TC-CFI implies a paradoxical embolic source.