双模态超声造影对偏头痛合并卵圆孔未闭诊断及脑血流动力学的评估价值OA

Objective To investigate the value of dual-modality contrast-enhanced ultrasound[contrast transthoracic echocardiography(C-TTE),contrast transcranial color doppler bubble test(C-TCCD)]in the diagnosis of migraine complicated with patent foramen ovale-right-to-left shunt(PFO-RLS)and evaluation of cerebral hemodynamics.Methods This retrospective study included 115 patients with migraine who were treated at the First Affiliated Hospital of Bengbu Medical University between July 2024 and July 2025.All patients underwent C-TTE,C-TCCD,and transesophageal echocardiography(TEE).TEE was used as the reference standard for the diagnosis of PFO,based on which patients were classified into PFO-positive and PFO-negative groups.Baseline characteristics,including gender,age,BMI,Headache Impact Test-6(HIT-6),Visual Analogue Scale(VAS),and Migraine Disability Assessment Scale(MIDAS)scores,were compared between the two groups.The sensitivity,specificity,accuracy,and other diagnostic indices of C-TTE,C-TCCD,and their combined application for detecting PFO-RLS were calculated.ROC curves were constructed to evaluate the AUC for each diagnostic approach.In addition,cerebral hemodynamic parameters of the right middle cerebral artery(MCA),including peak systolic velocity(PSV),end-diastolic velocity(EDV),mean velocity(MV),pulsatility index(PI),and resistance index(RI),were compared between groups.Results Among the 115 migraine patients,85 were classified as PFO-positive and 30 as PFO-negative.The MIDAS score was higher in the PFO-positive group than in the PFO-negative group(P<0.05),whereas no significant differences were observed in gender,age,BMI,HIT-6 score,or VAS score between the two groups(P>0.05).For the diagnosis of PFO-RLS,C-TTE showed a sensitivity of 0.835,a specificity of 0.733,an accuracy of 0.808,and an AUC of 0.784(95%CI:0.695-0.874).C-TCCD showed a sensitivity of 0.929,a specificity of 0.667,an accuracy of 0.861,and an AUC of 0.798(95%CI:0.708-0.888).The combined use of C-TTE and C-TCCD showed a sensitivity of 0.976,a specificity of 0.667,an accuracy of 0.895,and an AUC of 0.822(95%CI:0.734-0.909).Significant differences in PSV,EDV and MV were observed between the PFO-positive group and the PFO-negative group(P<0.01).Conclusion The combined application of C-TTE and C-TCCD provides superior diagnostic value for PFO-RLS compared with either modality alone.Differences exist in cerebral hemodynamics parameters between migraine patients with positive PFO and those with negative PFO.