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Diagnostic accuracy of transcranial doppler in the detection of patent foramen ovale: can it be considered a high-sensitivity screening test?

Journal of Neurology & Stroke
Rebeca Teixeira Costa, Viviane de Hiroki Flumignan Zétola, Gabriela Caetano Lopes Martins, Marcos Christiano Lange 

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Introduction: Patent foramen ovale (PFO) is an interatrial embryonic remnant that results in right-to-left (RLC) circulation communication, therefore associated with paradoxical embolic events. PFO is associated with cases of stroke of undetermined origin in young people, although it is present in approximately 30% of the general population and its incidental finding in complementary exams is common. The causal relationship has been explored in many published studies, and the search for high-risk markers has been the subject of numerous meta-analyses. Transcranial contrast Doppler (cTCD) is considered the screening test of choice because it is a low-cost, non-invasive diagnostic tool with high sensitivity and specificity. The exam considered the gold standard is the transesophageal echocardiogram (TEE). Methods: The database of the Neurosonology Laboratory of a University Hospital was used, reviewing information from 901 patients from January 2015 to May 2019. From this total (901), 217 patients who had undergone cTCD and TEE were included. The functional pattern by cTCD followed criteria previously published in the Latin American Consensus. Results: The assessment of the subgroup that had the cTCD and ETE performed, we found high sensitivity and specificity of cTCD when compared to the gold standard exam. Conclusion: Comparison of diagnostic tests for RLC resulted in a sensitivity of 95.9% and a specificity of 91.3%, with a PPV of 95.9% and a NPV of 91.3%.


transcranial doppler, screening, stroke, sensibility, transesophageal echocardiography