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Lee S, Kim IC, Kim YD, Nam HS, Kim SY, Choi SM, Chang HJ. The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke. Eur Radiol 2021; 31:8983-8990. [PMID: 34075451 DOI: 10.1007/s00330-021-08037-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES 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). METHODS AND RESULTS 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. CONCLUSION 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. KEY POINTS • 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.
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Affiliation(s)
- Seonhwa Lee
- 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
| | - In-Cheol Kim
- Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Young Dae Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - So Yeon Kim
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Seon Mi Choi
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuk-Jae Chang
- 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.
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Hur J, Kim YJ, Lee HJ, Ha JW, Heo JH, Choi EY, Shim CY, Kim TH, Nam JE, Choe KO, Choi BW. Cardiac Computed Tomographic Angiography for Detection of Cardiac Sources of Embolism in Stroke Patients. Stroke 2009; 40:2073-8. [DOI: 10.1161/strokeaha.108.537928] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jin Hur
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Jin Kim
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye-Jeong Lee
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Won Ha
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eui-Young Choi
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chi-Young Shim
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae Hoon Kim
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Eun Nam
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu Ok Choe
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Wook Choi
- From Department of Diagnostic Radiology (J.H., Y.J.K., H.-J.L., T.H.K., J.E.N., K.O.C., B.W.C.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology (J.-W.H., E.-Y.C., C.-Y.S.), Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (J.H.H.), Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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