Study Of Ultrasound Contrast Imaging In Diagnosis Of Right To Left Shunt And And Its Correlation With Migraine

Objective:1.To investigate the necessity of improving PFO diagnosis correct rate by the combined ultrasound contrast.2.To analyze the correlation between Right-to-left shunt(RLS)and the occurrence and clinical features of migraine.Methods:This study is a prospective study.Part I:A total of 311 people was included in the first part of the study from May 2015 till August2016.They were examined by contrast-Transcranial Doppler(c-TCD)?transthoracic echocardiography(TTE)?contrast-Transcranial Doppler(c-TCD)?contrast-Transthroracic Echocardiography(c-TTE)in the neurology department of First Hospital Affiliated to Nanhua University department.Part of them continue to improve transthoracic echocardiography(TEE)inspection.The results of c-TTE and TTE are compared with c-TCD.c-TCD was semi quantitatively graded and compared with TEE.35 cases of healthy volunteers and 144 cases of migraine patients were randomly assigned as second part whom were examined by c-TCD,to compare the incidence of RLS,type and shunt rate between migraine group and healthy group.At the same time,the relationship between RLS and clinical features of migraine was analyzed.Results:1.A total of 311 people at the same time to complete the c-TCD,TTE,c-TTE examination,and 123 people complete four checks:the c-TCD,TTE,c-TTE,TEE We randomly assigned 144 cases in migraine group and 35 cases in control group who completed the c-TCD.2.The positive predictive value of TEE and c-TTE were 100%and91.7%compared with c-TCD respectively,The negative predictive value of TEE and c-TTE were 30.4%and 60.3%compared with c-TCD respectively.Compared with TEE,the I-III grade shunt rate of c-TCD was gradually increased,and the difference was significant(44.4%vs 66.7%vs90.1%,P=0.02).c-TCD and TTE of 5 cases were negative c-TTE positive,confirmed by TEE PFO,and the average value of PFO 1.76mm.3.RLS and migrain:The positive rate of PFO-RLS in 144 cases of migraine group was higher than that of the healthy group(vs=34.3%,X~2=5.8,P<0.05),but the difference was significant in the large shunt group only.There was no difference between the c-TCD group and the healthy group(latent type 59.8%vs 66.7%,P>0.05;potential type 40.2%vs 33.3%,P>0.05).There was no statistically significant difference between c-TCD(+)group and c-TCD(-)group in clinical features of migraine,such as the incidence of aura?headache frequency?headache?accompanied by symptoms of nature?analgesic effect?family history of headache(P>0.05),only except special food predisposing factors(P=0.041).The headache degree of c-TCD(+)group was significantly higher than that of c-TCD(-)group migraine group(Z=-2.081,P=0.037).Conclusion:1.The combined ultrasound contrast can improve the diagnosis correct rate of patent foramen ovale.2.The occurrence of migraine is associated with a large number of shunt RLS,and the severity of migraine headache with RLS is more severe than without RLS.