title: Transcranial duplex sonography in the detection of patent foramen ovale.
abstract: OBJECTIVE
  To determine the sensitivity of contrast material-enhanced transcranial color-coded sonography (c-TCCS) compared with that of contrast-enhanced transesophageal echocardiography (c-TEE) for detection of cardiac right-to-left shunt.
  
  
  METHODS
  Forty consecutive patients with stroke or transient ischemic attack were admitted to the hospital and were examined by using c-TCCS and c-TEE. High-intensity transient signals (HITS) were counted for 25 seconds after the end of the Valsalva maneuver, and the numbers of HITS were classified in one of four categories (zero HITS, one to 10 HITS, >10 HITS without curtain, and curtain). A statistically significant difference was calculated with the Fisher exact test.
  
  
  RESULTS
  HITS were counted in 21 (52%) patients by using c-TCCS and c-TEE. With both tests, no HITS were counted in 15 (38%) patients. In two (5%) patients, no HITS were counted with c-TEE but three HITS in one patient and five HITS in the other were counted with c-TCCS. In two (5%) patients, no HITS were counted with c-TCCS, but a small patent foramen ovale (PFO) was seen at c-TEE. With c-TCCS, the sensitivity was 91% (21 of 23) and the specificity was 88% (15 of 17). In 23 patients examined with c-TCCS, 14 (61%) patients had category 1 PFO; seven (30%) patients, category 2 PFO; and two (9%) patients, category 3 PFO. Mean HITS count in patients with category 1 PFO was 4.4 and that for those with category 2 PFO was 27.6.
  
  
  CONCLUSIONS
  c-TCCS is a sensitive noninvasive method for detecting cardiac right-to-left shunt and is as sensitive as c-TEE.
authors.affiliation: Department of Neurology, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany. wendelin.blersch@klinik.uni-regensburg.de
authors.forename: Wendelin K
authors.initials: WK
authors.lastname: Blersch
authors.forename: Bogdan M
authors.initials: BM
authors.lastname: Draganski
authors.forename: Stefan R
authors.initials: SR
authors.lastname: Holmer
authors.forename: Horst J
authors.initials: HJ
authors.lastname: Koch
authors.forename: Felix
authors.initials: F
authors.lastname: Schlachetzki
authors.forename: Ullrich
authors.initials: U
authors.lastname: Bogdahn
authors.forename: Thilo
authors.initials: T
authors.lastname: Hölscher
mesh_terms: D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging; D017585:Ultrasonography, Doppler, Transcranial