Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Eur Radiol. 2021 Dec;31(12):8983-8990. doi: 10.1007/s00330-021-08037-y. Epub 2021 Jun 1.
We explored the hypothesis that the diagnostic performance of cardiac computed tomography (CT) throughout the full cardiac cycle would be superior to single-phase CT and comparable to transesophageal echocardiography (TEE) in diagnosing patent foramen ovale (PFO).
From May 2011 to April 2015, 978 patients with stroke were diagnosed with PFO by TEE. In patients with stroke, cardiac CT was performed if the patients had more than two cardiovascular risk factors. We prospectively enrolled 70 patients with an indication for cardiac CT. Cardiac CT images were reconstructed at 10% increments of the R-R interval. The sensitivity of cardiac CT throughout the full cardiac cycle in diagnosing PFO was compared to that for TEE and single-phase cardiac CT. To evaluate the specificity of cardiac CT, we analyzed patients without PFO confirmed by TEE who underwent cardiac CT within 1 month of pre-cardiac surgery. Sixty-six patients with cardiac CT and TEE were included in the final analysis. Throughout the full cardiac cycle, cardiac CT had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing PFO, compared to TEE as a reference. PFO was primarily detected in the 60% and 70% intervals in 10-phase reconstructed images. The sensitivity of PFO diagnosis with cardiac CT was 81.8% when analyzing both the 60% and 70% intervals instead of the full cardiac cycle.
Cardiac CT throughout the full cardiac cycle outperforms single-phase cardiac CT in detecting PFO. Cardiac CT can be used as an alternative method to TEE for detecting PFO in stroke patients.
• Throughout the full cardiac cycle, cardiac computed tomography (CT) had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing patent foramen ovale (PFO), compared to transesophageal echocardiography. • The sensitivity of diagnosing patent foramen ovale with cardiac CT was 81.8% when analyzing 60% and 70% R-R intervals instead of the full cardiac cycle. • Cardiac CT with retrospective electrocardiographic gating throughout the full cardiac cycle can increase the detectability of PFO, compared to single-phase cardiac CT.
我们探究了一个假设，即心脏 CT 全心动周期扫描在诊断卵圆孔未闭（PFO）方面的诊断性能优于单时相 CT，且与经食管超声心动图（TEE）相当。
从 2011 年 5 月至 2015 年 4 月，共有 978 例脑卒中患者经 TEE 诊断为 PFO。如果脑卒中患者存在两个以上心血管危险因素，则行心脏 CT 检查。我们前瞻性纳入了 70 例有心脏 CT 适应证的患者。心脏 CT 图像以 R-R 间期的 10%递增重建。比较全心动周期心脏 CT 诊断 PFO 的敏感性与 TEE 和单时相心脏 CT 的敏感性。为了评估心脏 CT 的特异性，我们分析了在心脏手术前 1 个月内行心脏 CT 且 TEE 未发现 PFO 的患者。最终有 66 例患者同时行心脏 CT 和 TEE 检查并纳入最终分析。全心动周期心脏 CT 诊断 PFO 的敏感性为 89.4%，特异性为 92.3%，以 TEE 为参照。在 10 时相重建图像中，PFO 主要在 60%和 70%的时相区间被检出。分析 60%和 70%的时相区间而不是全心动周期时，心脏 CT 诊断 PFO 的敏感性为 81.8%。
全心动周期心脏 CT 检测 PFO 的性能优于单时相心脏 CT。心脏 CT 可作为 TEE 检测脑卒中患者 PFO 的替代方法。
与 TEE 相比，全心动周期心脏 CT 诊断 PFO 的敏感性为 89.4%，特异性为 92.3%。
分析 60%和 70%的 R-R 间期而不是全心动周期时，心脏 CT 诊断 PFO 的敏感性为 81.8%。
与单时相心脏 CT 相比，全心动周期回顾性心电门控心脏 CT 可提高 PFO 的检出率。
