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Need for performance protocols in TEE and TCD for detection of right to left shunts.

Authors :
Chang J
Darbonne C
Drumm DA
Teleb MS
Frey JL
Source :
Journal of neuroimaging : official journal of the American Society of Neuroimaging [J Neuroimaging] 2014 Mar-Apr; Vol. 24 (2), pp. 144-8. Date of Electronic Publication: 2012 Aug 22.
Publication Year :
2014

Abstract

Background and Purpose: Although transesophageal echocardiography (TEE) is the gold standard for right to left shunt detection, we observed that transcranial Doppler (TCD) was more sensitive and sought an explanation.<br />Methods: We retrospectively evaluated results of TCD and TEE in 118 patients with cryptogenic stroke and transient ischemic attacks. TCDs were done as per modification of a published performance protocol and interpreted by a neurologist and radiologist. TEEs were performed and interpreted by five cardiologists without standardized protocol. Statistical methodology included χ(2) tests, Fisher exact tests, and ANOVA.<br />Results: Overall agreement between TCD and TEE was found for 76 of 118 patients. Sensitivities of TCD and TEE were 93.8% and 53.1%. Sensitivities for TCD interpreters were 61.1% and 64.1%. Sensitivities for TEE operators varied from 46.7% to 75.7%. We were unable to find a performance protocol for TEE microbubble studies in either published literature or certification organizations.<br />Conclusions: TEEs and TCDs are operator dependent and thus subject to false negatives. The lower yield and interoperator variability in TEE results appear to reflect the lack of performance protocols and engender concern about false negatives in community use. Consensus performance protocols and certification criteria for both modalities should have an impact on accuracy of shunt detection.<br /> (Copyright © 2012 by the American Society of Neuroimaging.)

Details

Language :
English
ISSN :
1552-6569
Volume :
24
Issue :
2
Database :
MEDLINE
Journal :
Journal of neuroimaging : official journal of the American Society of Neuroimaging
Publication Type :
Academic Journal
Accession number :
22913674
Full Text :
https://doi.org/10.1111/j.1552-6569.2012.00729.x