Patent foramen ovale: diagnosis with multidetector CT--comparison with transesophageal echocardiography.
OBJECTIVE
To evaluate the clinical feasibility and accuracy of 64-section multidetector computed tomography (CT) compared with transesophageal echocardiography (TEE) for diagnosis of a patent foramen ovale (PFO).


METHODS
Institutional review board approval was obtained for this retrospective study. The study included 152 consecutive stroke patients (mean age, 61.7 years; 98 men, 54 women) who underwent both cardiac multidetector CT and TEE. Electrocardiographically gated cardiac CT was performed with a 64-section CT scanner by using a saline-chaser contrast agent injection technique. A contrast agent jet from the contrast agent-filled left atrium (LA) to the saline-filled right atrium (RA) and channel-like appearance of the interatrial septum (IAS) were evaluated on axial and oblique sagittal CT images. Two-dimensional and Doppler TEE were performed to detect PFO. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT were obtained with TEE as the reference standard.


RESULTS
A PFO was present in 26 patients at TEE. On CT images, a left-to-right contrast agent jet toward the inferior vena cava was noted in 21 patients (sensitivity, 73.1%; specificity, 98.4%; PPV, 90.5%; NPV, 94.7%). Channel-like appearance of the IAS was detected in 38 patients (sensitivity, 76.9%; specificity, 85.7%; PPV, 52.6%; NPV, 94.7%). Channel-like appearance of the IAS was noted in all patients who had a contrast agent jet.


CONCLUSIONS
A contrast agent jet from LA to RA toward the inferior vena cava with channel-like appearance of the IAS on CT images confirms the presence of a PFO.
Kim
Young Jin
YJ
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University Health System, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea.
Hur
Jin
J
Shim
Chi-Young
CY
Lee
Hye-Jeong
HJ
Ha
Jong-Won
JW
Choe
Kyu Ok
KO
Heo
Ji Hoe
JH
Choi
Eui-Young
EY
Choi
Byoung Wook
BW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis; D005240:Feasibility Studies; D005260:Female; D054092:Foramen Ovale, Patent / Q000175:diagnosis*; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012965:Sodium Chloride; D036542:Tomography, Spiral Computed
D003287:Contrast Media; D012965:Sodium Chloride; D007479:Iopamidol