Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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Comparison of the Right-to-left Shunt Test by Transcranial Doppler Based on the Addition of Blood and Patient Posture

경두개 초음파를 이용한 좌우단락검사 시 Blood 사용 유무와 환자 자세에 따른 실증적 결과 비교

  • Kun-Woo KANG (Neurology Laboratory, Samsung Medical Center) ;
  • Eui-Jeong LEE (Neurology Laboratory, Samsung Medical Center) ;
  • Hyun-Kyung LEE (Neurology Laboratory, Samsung Medical Center) ;
  • Eun-Son LEE (Neurology Laboratory, Samsung Medical Center) ;
  • Yang-Hee LIM (Neurology Laboratory, Samsung Medical Center)
  • 강건우 (삼성서울병원 신경검사실) ;
  • 이의정 (삼성서울병원 신경검사실) ;
  • 이현경 (삼성서울병원 신경검사실) ;
  • 이은선 (삼성서울병원 신경검사실) ;
  • 임양희 (삼성서울병원 신경검사실)
  • Received : 2024.07.29
  • Accepted : 2024.09.06
  • Published : 2024.09.30
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Abstract

Using transcranial doppler ultrasonography (TCD) to measure the presence or absence of abnormalities in patent foramen ovale (PFO) is more effective than transesophageal echocardiography (TEE) because it is simple, inexpensive, and non-invasive. Thus, it can be a good alternative test in cases where it is difficult to perform TEE or in groups at a high risk of complications. Therefore, in this study, we sought to assist in arriving at a diagnosis by suggesting an appropriate method through the comparison of empirical results according to the presence or absence of blood use and varying patient posture. The results were compared depending on the patient's posture and whether blood was used. Patients in whom both middle cerebral arteries were observed were targeted. In cases where the temporal window was defective, it was replaced with basilar artery and compared. There were higher positivity rate and accuracy for sitting position using valsalva maneuver (VM) than for Resting and supine position using VM. Therefore, if it is possible to perform a sitting position using VM with a mixture of blood, it would be a good idea to perform it.

경두개 초음파(transcranial doppler ultrasonography, TCD)를 이용한 난원공 개존증(patent foramen ovale)의 이상 유무를 측정하는 방법은 경식도 심장초음파검사(transesophageal echocardiography, TEE)에 비해 간단하고 비용이 저렴하며 비침습적이기 때문에 보다 효과적인 방법이다. 특이도 및 양성 예측도도 높기 때문에 TEE를 시행하기 어렵거나 합병증 고위험군인 경우 좋은 대체 검사가 될 수 있다. 그래서 본 연구에서는 TCD를 통해 보다 효과적이고 정확한 검사결과를 얻기 위한 방법으로 blood 사용 유무와 환자 자세에 따른 실증적 결과 비교를 통해 적절한 방법을 제안함으로써 진단에 도움을 주고자 한다. Blood 사용 여부와 환자 자세에 따른 결과를 비교하였고, 양쪽 중간대뇌동맥(middle cerebral artery)이 모두 관찰된 환자를 대상으로 하였다. 그리고 측두부창이 불량인 경우는 뇌바닥동맥(basilar artery)으로 대체해서 비교하였다. Blood를 혼합했을 때 positive가 더 많은 것으로 나타났다. Resting과 supine position using valsalva maneuver (VM) 보다 sitting position using VM에서 positive가 더 많은 것으로 나타났고 정확도도 더 높은 것으로 나타났다. 이에 blood를 혼합한 상태에서 sitting position using VM 방법이 가능하다면 시행하는 것이 좋을 것으로 생각된다.

Keywords

References

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