Contrast transcranial doppler ultrasound in the detection of right-to- left shunts

Time window and threshold in microbubble numbers

Dirk W. Droste, Karen Silling, Jörg Stypmann, Matthias Grude, V. Kemény, Thomas Wichter, Karsten Kühne;, E. Bernd Ringelstein

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1640-1645
Number of pages6
JournalStroke
Volume31
Issue number7
Publication statusPublished - Jul 2000

Fingerprint

Valsalva Maneuver
Microbubbles
Doppler Ultrasonography
Transesophageal Echocardiography
Injections
Contrast Media
Middle Cerebral Artery
Patient Rights
Galactose
Sensitivity and Specificity

Keywords

  • Cerebral embolism
  • Cerebrovascular disorders
  • Foramen ovale, patent
  • Ultrasonography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Droste, D. W., Silling, K., Stypmann, J., Grude, M., Kemény, V., Wichter, T., ... Ringelstein, E. B. (2000). Contrast transcranial doppler ultrasound in the detection of right-to- left shunts: Time window and threshold in microbubble numbers. Stroke, 31(7), 1640-1645.

Contrast transcranial doppler ultrasound in the detection of right-to- left shunts : Time window and threshold in microbubble numbers. / Droste, Dirk W.; Silling, Karen; Stypmann, Jörg; Grude, Matthias; Kemény, V.; Wichter, Thomas; Kühne;, Karsten; Ringelstein, E. Bernd.

In: Stroke, Vol. 31, No. 7, 07.2000, p. 1640-1645.

Research output: Contribution to journalArticle

Droste, DW, Silling, K, Stypmann, J, Grude, M, Kemény, V, Wichter, T, Kühne;, K & Ringelstein, EB 2000, 'Contrast transcranial doppler ultrasound in the detection of right-to- left shunts: Time window and threshold in microbubble numbers', Stroke, vol. 31, no. 7, pp. 1640-1645.
Droste, Dirk W. ; Silling, Karen ; Stypmann, Jörg ; Grude, Matthias ; Kemény, V. ; Wichter, Thomas ; Kühne;, Karsten ; Ringelstein, E. Bernd. / Contrast transcranial doppler ultrasound in the detection of right-to- left shunts : Time window and threshold in microbubble numbers. In: Stroke. 2000 ; Vol. 31, No. 7. pp. 1640-1645.
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AU - Silling, Karen

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AU - Grude, Matthias

AU - Kemény, V.

AU - Wichter, Thomas

AU - Kühne;, Karsten

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