{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T13:37:54Z","timestamp":1781530674190,"version":"3.54.1"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T00:00:00Z","timestamp":1599523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neuroimaging"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>BACKGROUND AND PURPOSE<\/jats:title><jats:p>The identification of high\u2010risk patent foramen ovale (PFO) is important for selecting suitable patients for PFO closure to prevent recurrent stroke in those with cryptogenic stroke. We aimed to evaluate the predictability of transcranial Doppler (TCD) in diagnosing high\u2010risk PFO compared with that of transesophageal echocardiography (TEE), which is not feasible for some stroke patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>We retrospectively reviewed the data of 461 cryptogenic stroke patients who underwent TEE and TCD for PFO evaluation. High\u2010risk PFO on TEE was defined as PFO with atrial septal aneurysm (phasic septal excursion \u226510 mm) or large PFO (\u22652 mm). Spencer grading of right\u2010to\u2010left shunt was used to classify the amount of shunt on TCD.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>PFO on TEE was observed for 242 (52.5%) patients, and high\u2010risk PFO was detected for 123 (26.7%) patients. However, PFO on TCD was observed for 336 (72.9%) patients. Among patients with significant shunt (Spencer grade III or higher) who underwent TCD after Valsalva maneuver (VM), 60.0% of patients had high\u2010risk PFO. However, only 5.3% of patients had high\u2010risk PFO among those without significant shunt. Receiver operating characteristic curves showed that significant shunt after VM had higher predictability (AUC = .876, 95% CI: .843\u2010.905) for detecting the high\u2010risk PFO compared with the predictability based on significant shunt at rest (AUC = .718, 95% CI: .674\u2010.759). (<jats:italic>P<\/jats:italic>&lt;.0001 for the differences between two AUCs).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>TCD is a good screening tool for evaluating high\u2010risk PFO. VM is important for the evaluation of PFO. Patients with minimal or no shunt on TCD after VM are unlikely to have high\u2010risk PFO.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jon.12783","type":"journal-article","created":{"date-parts":[[2020,9,9]],"date-time":"2020-09-09T07:47:42Z","timestamp":1599637662000},"page":"165-170","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Transcranial Doppler as a Screening Tool for High\u2010Risk Patent Foramen Ovale in Cryptogenic Stroke"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0504-2539","authenticated-orcid":false,"given":"Seongho","family":"Park","sequence":"first","affiliation":[{"name":"Department of Neurology, Haeundae Paik Hospital Inje University College of Medicine  Busan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Kyung","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center University of Ulsan College of Medicine  Seoul Korea"},{"name":"Division of Cardiology, Department of Internal Medicine Sejong Chungnam National University Hospital, Chungnam National University College of Medicine  Daejeon Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae\u2010Kwan","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boseong","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Neurology, Asan Medical Center University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bum Joon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Asan Medical Center University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong S.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Asan Medical Center University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong\u2010Wha","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Asan Medical Center University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Young","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Asan Medical Center University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Sung","family":"Lee","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center University of Ulsan College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun U.","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Neurology, Asan Medical Center University of Ulsan College of Medicine  Seoul 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