[Neuroimaging features of white matter lesions related to patent foramen ovale]

A retrospective analysis was conducted on the neuroimaging features of white matter lesions related to patent foramen ovale and clinical characteristics (age, sex, history of hypertension and diabetes, etc.) of patients who underwent patent foramen ovale closure surgery at Fuwai Hospital, Chinese Academy of Medical Sciences, from February 2021 to June 2025. All patients were confirmed to have right-to-left shunt by contrast-enhanced transthoracic echocardiography and completed brain MRI examination. According to the results of contrast-enhanced transthoracic echocardiography, patients were divided into 2 groups (large-shunt group and non-large-shunt group). The distribution characteristics of white matter lesions were investigated from multiple dimensions, including anterior/posterior circulation, left/right hemisphere, and single/multiple lesions. A total of 118 patients were screened, among whom 100 with complete clinical data were included in the study. The age was (45.4±9.9) years. There were 62(62%) cases in the large-shunt group and 38(38%) cases in the non-large-shunt group. No statistically significant differences were found between the 2 groups in terms of age, gender, or history of hypertension, diabetes, stroke or transient ischemic attack (TIA). The proportion of multiple white matter lesions in the large-shunt group was significantly different [59.7%(37/62) vs 39.5%(15/38), P=0.049], as was the proportion of bilateral hemispheric distribution [62.9%(39/62) vs 42.1%(16/38), P=0.042]. The proportion of lesions distributed in the right hemisphere was higher [66.1%(41/62) vs 47.4%(18/38)], but the difference did not reach statistical significance (P=0.064). Among patients with a history of stroke or TIA, the proportions of multiple, bilateral, and involvement of both anterior and posterior circulation white matter lesions were significantly higher than those without such histor[66.1%(39/59) vs 31.7%(13/41), 67.8%(40/59) vs 36.6%(15/41), 62.7%(37/59) vs 26.8%(11/41), all P<0.01]. No statistically significant difference in white matter lesions distribution was observed between patients with and without a history of migraine. Patients with patent foramen ovale and a large right-to-left shunt are more likely to present with bilateral and multiple cerebral white matter lesions on brain MRI, and these white matter lesions are more prone to occur in the right hemisphere.