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Diagnostic Performance of MDCT for Detecting Aortic Valve Regurgitation

Gudrun M. Feuchtner1, Wolfgang Dichtl2, Thomas Schachner3, Silvana Müller2, Ammar Mallouhi1, Guy J. Friedrich2 and Dieter zur Nedden1

1 Clinical Department of Radiology II, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria.
2 Clinical Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria.
3 Clinical Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.


Figure 1
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  		Fig. 1A —Aortic valve (normal finding) appeared closed in two patients without aortic regurgitation during mid-to-late diastole. 67-year-old man with degenerative aortic stenosis. Tricuspid valve morphology and moderate valve calcifications (white) (Agatston calcium score [ACS]: 1997.1) were displayed by using volume-rendering technique (VRT) slab.

 

Figure 2
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  		Fig. 1B —Aortic valve (normal finding) appeared closed in two patients without aortic regurgitation during mid-to-late diastole. 75-year-old woman with degenerative aortic stenosis. Bicuspid valve morphology and moderate valve calcifications (white) (ACS: 2018.3) are shown by applying 3D VRT slab. VRT was preferred to show localization and extent of valve calcifications, which can provide interesting information to cardiac surgeons.

 

Figure 3
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  		Fig. 2A —47-year-old man with degenerative aortic stenosis. Concomitant moderate aortic regurgitation (grade 2+) is shown on cross-sectional transverse plane by applying multiplanar reformation (multiplanar reconstruction). Aortic valve leaflets did not close up tightly at diastole, and central triangular valvular leakage was revealed.

 

Figure 4
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  		Fig. 2B —47-year-old man with degenerative aortic stenosis. Central aortic regurgitation area (AR) was circled with digital caliper and calculated in cm2. Valve calcifications (arrow) might limit accurate quantification of aortic regurgitation area. RCC = right coronary cusp, LCC = left coronary cusp, NCC = noncoronary cusp.

 

Figure 5
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  		Fig. 3 —56-year-old woman with moderate aortic regurgitation (grade 2+) without valve calcifications. Note central triangular valvular leakage area.

 

Figure 6
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  		Fig. 4A —68-year-old man who had previous coronary bypass surgery and who underwent 16-MDCT angiography because of recurrent angina pectoris. Volume-rendering technique displays coronary bypass grafts: left internal thoracic artery and venous aortocoronary bypass graft (white arrow); right coronary artery with heavy calcifications and calcifying plaque at ascending aorta (black arrow) (white spots).

 

Figure 7
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  		Fig. 4B —68-year-old man who had previous coronary bypass surgery and who underwent 16-MDCT angiography because of recurrent angina pectoris. Moderate aortic regurgitation (grade 2+) with valve calcifications (white) was detected by applying multiplanar reconstruction. Note that aortic valve is prone to calcify in patients with coronary artery disease.

 

Figure 8
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  		Fig. 5A —57-year-old man with ascending aortic aneurysm. Ascending aortic aneurysm, which is frequently associated with aortic regurgitation, is shown with multiplanar reconstruction (left coronal oblique view).

 

Figure 9
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  		Fig. 5B —57-year-old man with ascending aortic aneurysm. Cross-sectional image of bicuspid valve shows central valvular leakage corresponding to moderate aortic regurgitation (grade 2+) without valve calcifications.

 

Figure 10
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  		Fig. 6 —48-year-old man who underwent 16-MDCT coronary angiography for suspected coronary artery disease. Mild aortic regurgitation (grade 1+) was incidental finding and appeared "spotlike," which may be easy to miss.

 

Figure 11
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  		Fig. 7 —66-year-old man with known degenerative aortic stenosis accompanied by severe valve calcifications (Agatston score: 10,107.2) and mild aortic regurgitation as assessed with transthoracic echocardiography. 16-MDCT could not detect aortic regurgitation because heavy valve calcifications located at valve leaflets margins prevented accurate display of central valvular leakage area.

 

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