Objective: To explore the diagnostic value of contrast-enhanced transesophageal echocardiography (c-TTE) and contrast-enhanced transcranial doppler (c-TCD) in patients with cryptogenic stroke with patent foramen ovale (PFO). Methods: 102 patients with cryptogenic stroke who were diagnosed and treated in our hospital from January 2020 to December 2022 were selected. All patients underwent c-TCD examination and right heart contrast echocardiography. Transesophageal echocardiography (TEE) was used as the diagnostic gold standard. The diagnostic value of right heart contrast echocardiography and c-TCD examination for PFO in patients with cryptogenic stroke was compared. Results: TEE examination confirmed 44 cases of PFO in 102 patients with concealed stroke. The results of c-TCD examination showed that 36 cases were true positive

10 cases were false positive

8 cases were false negative

and 48 cases were true negative; The results of c-TTE showed that there were 42 cases of true positive

3 cases of false positive

2 cases of false negative and 55 cases of true negative. The analysis of the working characteristic (ROC) curve of the subjects showed that the AUC of c-TCD and c-TTE in the diagnosis of PFO in patients with occult stroke were 0.823 and 0.951 respectively

and the sensitivity

specificity and accuracy of c-TCD in the diagnosis of PFO in patients with occult stroke were 81.82%

82.76% and 82.35% respectively

which were significantly lower than 95.45%

94.83% and 95.10% of c-TTE (P<0.05). The semi-quantitative grading of right-to-left shunt by c-TCD was lower than that of c-TTE (P<0.05)

and the detection rate of right-to-left shunt by c-TCD was 30.39%

significantly lower than 58.82% of c-TTE (P<0.05). Conclusion: Compared with c-TCD

c-TTE has higher diagnostic value for cryptogenic stroke patients with PFO

and the degree of semi-quantitative grading of right-to-left shunt is higher and the detection rate is higher for cryptogenic stroke patients with PFO.