title: Patent foramen ovale: diagnosis with multidetector CT--comparison with transesophageal echocardiography.
abstract: 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.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University Health System, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jin
authors.initials: J
authors.lastname: Hur
authors.forename: Chi-Young
authors.initials: CY
authors.lastname: Shim
authors.forename: Hye-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
authors.forename: Kyu Ok
authors.initials: KO
authors.lastname: Choe
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
mesh_terms: 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
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride; D007479:Iopamidol