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DOI: 10.1148/radiol.2491071874
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(Radiology 2008;249:338-345.)
© RSNA, 2008

Thoracic Imaging

Patent Foramen Ovale: Detection with Nongated Multidetector CT1

Marie-Pierre Revel, MD, Jean-Baptiste Faivre, MD, Thierry Letourneau, MD, PhD, Hilde Henon, MD, PhD, Didier Leys, MD, Valérie Delannoy-Deken, MS, Martine Remy-Jardin, MD, PhD, and Jacques Remy, MD

1 From the Department of Radiology, Calmette Hospital, Centre Hospitalier Regional Universitaire de Lille, University of Lille-2, Boulevard Jules Leclercq, 59037 Lille, France (M.P.R., J.B.F., M.R., J.R.); Department of Cardiovascular Imaging, Cardiology Hospital, University of Lille-2, Lille, France (T.L.); Department of Neurology, Roger Salengro Hospital, University of Lille-2, Lille, France (H.H., D.L.); and Department of Medical Statistics, University of Lille-2, Lille, France (V.D.). From the 2007 RSNA Annual Meeting. Received October 29, 2007; revision requested January 31, 2008; revision received March 22; accepted April 11; final version accepted April 15. Address correspondence to M.R. (e-mail: mremy-jardin{at}chru-lille.fr).

Purpose: To evaluate nongated multidetector computed tomography (CT) in the detection of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) in comparison with transesophageal echocardiography (TEE).

Materials and Methods: The study was approved by the institutional review board, and informed consent was obtained from all patients. One hundred five patients (57 men, 48 women; mean age, 53 years) with a recent stroke underwent TEE and multidetector CT on the same day. After injection of a diluted iodinated contrast material, a series of 2.4-mm-thick transverse images centered on the fossa ovalis were acquired in conjunction with release of the Valsalva maneuver. Two independent radiologists considered PFO present if left atrial enhancement was detected visually before enhancement of the pulmonary veins or if an early peak of left atrial enhancement was found at time-attenuation curve analysis.

Results: PFO was detected with 98% specificity (95% confidence interval [CI]: 0.91, 0.99). Overall sensitivity was 55% (95% CI: 0.38, 0.70), ranging from 28% for shunts classified as grade 1 at TEE to 91% for those classified as grade 4 at TEE. Interreader agreement was good ({kappa} = 0.81). Visual assessment was better than time-attenuation curve analysis, which enabled detection of only 15 of the 40 cases of PFO. Multidetector CT depicted only 22% of cases of ASA. The mean effective radiation dose was 2.3 mSv.

Conclusion: Nongated multidetector CT can be used to diagnose high-grade shunts through a PFO, with 91% sensitivity and 98% specificity. Thus, PFO detection, in addition to routine CT evaluation of the lungs, could be indicated in patients with unexplained hypoxemia.

© RSNA, 2008