Computed Tomography for Detecting Patent Foramen Ovale: A Meta-Analysis
DOI:
https://doi.org/10.1532/hsf.5049Keywords:
cardiovascular computed tomography, transesophageal echocardiography, patent foramen ovale, meta-analysisAbstract
Objective: Patent foramen ovale (PFO) has been regarded as a potential source of cryptogenic stroke, which was conventionally detected by transesophageal echocardiography. Cardiac computed tomography (CCT) is a promising, noninvasive test for detection of PFO. We sought to conduct a meta-analysis to evaluate the diagnostic performance of CCT in detecting PFO.
Methods: PubMed, ISI Web of Knowledge, Embase, Cochrane Library, and Wanfang from inception to June 2020 were searched for relevant studies comparing CCT and transesophageal echocardiography as the reference standard in detecting PFO. A bivariate model was used to pool sensitivity and specificity and to construct summary receiver operating characteristic (SROC) curves.
Results: A total of seven studies with 483 patients were included in this meta-analysis. For the diagnosis of PFO, CCT had a mean sensitivity and specificity of 0.70 [95% CI:0.58, 0.79] and 0.97 [95% CI: 0.95, 0.99]. The SROC analysis showed an area under the curve of 0.97.
Conclusion: CCT shows good diagnostic accuracy in detecting PFO with relatively high sensitivity and specificity. CCT could be considered a noninvasive alternative to transesophageal echocardiography for detecting PFO.
References
Boussel L, Cakmak S, Wintermark M, Nighoghossian N, Loffroy R, Coulon P, et al. 2011. Ischemic stroke: etiologic work-up with multidetector CT of heart and extra- and intracranial arteries. Radiology. 258(1):206-12.
Fonseca AC, Ferro JM. 2015. Cryptogenic stroke. Eur J Neurol. 22(4):618-23.
Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. 2003. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol. 56(11):1129-35.
Hara H, Virmani R, Ladich E, Mackey-Bojack S, Titus J, Reisman M, et al. 2005. Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol. 46(9):1768-76.
Hur J, Kim YJ, Lee HJ, Ha JW, Heo JH, Choi EY, et al. 2009. Cardiac computed tomographic angiography for detection of cardiac sources of embolism in stroke patients. Stroke. 40(6):2073-8.
Kim YJ, Hur J, Shim CY, Lee HJ, Ha JW, Choe KO, et al. 2009. Patent foramen ovale: diagnosis with multidetector CT--comparison with transesophageal echocardiography. Radiology. 250(1):61-7.
Lee S, Kim IC, Kim YD, Nam HS, Kim SY, Choi SM, et al. 2021. The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke. Eur Radiol. 31(12):8983-8990.
Mojadidi MK, Bogush N, Caceres JD, Msaouel P, Tobis JM. 2014. Diagnostic accuracy of transesophageal echocardiogram for the detection of patent foramen ovale: a meta-analysis. Echocardiography. 31(6):752-8.
Mojadidi MK, Winoker JS, Roberts SC, Msaouel P, Zaman MO, Gevorgyan R, et al. 2014. Accuracy of conventional transthoracic echocardiography for the diagnosis of intracardiac right-to-left shunt: a meta-analysis of prospective studies. Echocardiography. 31(9):1036-48.
Ning M, Lo EH, Ning PC, Xu SY, McMullin D, Demirjian Z, et al. 2013. The brain's heart - therapeutic opportunities for patent foramen ovale (PFO) and neurovascular disease. Pharmacol Ther. 139(2):111-23.
Resen MS, Poulsen MB, Overgaard K, Rasmussen RS, Soja AMB, Nilsson B, et al. 2020. Cardiovascular computed tomography versus transoesophageal echocardiography after cryptogenic ischaemic stroke - a pilot study of 12 patients. J Int Med Res. 48(1):300060518764220.
Revel MP, Faivre JB, Letourneau T, Henon H, Leys D, Delannoy-Deken V, et al. 2008. Patent foramen ovale: detection with nongated multidetector CT. Radiology. 249(1):338-45.
Saremi F, Channual S, Raney A, Gurudevan SV, Narula J, Fowler S, et al. 2008. Imaging of patent foramen ovale with 64-section multidetector CT. Radiology. 249(2):483-92.
Williamson EE, Kirsch J, Araoz PA, Edmister WB, Borgeson DD, et al. 2008. ECG-gated cardiac CT angiography using 64-MDCT for detection of patent foramen ovale. AJR Am J Roentgenol. 190(4):929-33.
Yamashita E, Murata T, Goto E, Fujiwara T, Sasaki T, Minami K, et al. 2017. Inferior Vena Cava Compression as a Novel Maneuver to Detect Patent Foramen Ovale: A Transesophageal Echocardiographic Study. J Am Soc Echocardiogr. 30(3):292-299.
