Patent foramen ovale: Diagnosis with multidetector CT-comparison with transesophageal echocardiography

Purpose: 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).Materials and Methods: Institutional review board approval was obtained for this retrospective study. The studyincluded 152 consecutive stroke patients (mean age, 61.7 years; 98 men, 54 women) who underwent both cardiacmultidetector CT and TEE. Electrocardiographically gated cardiac CT was performed with a 64-section CT scannerby using a saline-chaser contrast agent injection technique. A contrast agent jet from the contrast agent-filled leftatrium (LA) to the saline-filled right atrium (RA) and channel-like appearance of the interatrial septum (IAS) wereevaluated on axial and oblique sagittal CT images. Two-dimensional and Doppler TEE were performed to detectPFO. 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, aleft-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 patientswho had a contrast agent jet. Conclusion: A contrast agent jet from LA to RA toward the inferior vena cava withchannel-like appearance of the IAS on CT images confirms the presence of a PFO.