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MDCT Detection of Mitral Valve Calcification: Prevalence and Clinical Relevance Compared with Echocardiography

Andreas H. Mahnken1,2, Georg Mühlenbruch1, Marco Das1, Joachim E. Wildberger1, Harald P. Kühl3, Rolf W. Günther1, Malte Kelm3 and Ralf Koos3

1 Department of Diagnostic Radiology, University Hospital, RWTH-Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany.
2 Applied Medical Engineering, Helmholtz Institute, RWTH-Aachen University, Aachen, Germany.
3 Department of Internal Medicine I, University Hospital, RWTH-Aachen University, Aachen, Germany.


Figure 1
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  		Fig. 1A —Classification of mitral valve annulus and mitral valve leaflet. Detection of mitral valve leaflet (arrow, A) or annulus (arrow, B) calcification requires minimum amount of calcium.

 

Figure 2
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  		Fig. 1B —Classification of mitral valve annulus and mitral valve leaflet. Detection of mitral valve leaflet (arrow, A) or annulus (arrow, B) calcification requires minimum amount of calcium.

 

Figure 3
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  		Fig. 1C —Classification of mitral valve annulus and mitral valve leaflet. In patients presenting with both mitral valve leaflet (arrows) and annulus (arrowhead) calcification separation of anatomic structures was feasible from their position on axial CT images because mitral valve apparatus is positioned horizontally to scanning plane.

 

Figure 4
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  		Fig. 2A —57-year-old man without mitral valve disease. MDCT scan shows neither mitral valve leaflet nor mitral valve annulus calcification (grade 0).

 

Figure 5
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  		Fig. 2B —57-year-old man without mitral valve disease. Echocardiogram shows normal mitral valve.

 

Figure 6
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  		Fig. 3A —71-year-old man with mild calcification (grade 1). Contrast-enhanced MDCT scan shows calcification in posterior leaflet of mitral valve (arrow).

 

Figure 7
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  		Fig. 3B —71-year-old man with mild calcification (grade 1). Corresponding echocardiogram reveals mild mitral stenosis.

 

Figure 8
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  		Fig. 4A —75-year-old man with moderate calcification. MDCT scan shows mainly mitral valve annulus but also mitral valve leaflet calcification (grade 2), indicating mitral valve stenosis. Pleural effusion is also present.

 

Figure 9
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  		Fig. 4B —75-year-old man with moderate calcification. Echocardiogram shows typical diastolic doming (arrows) and confirms moderate mitral valve stenosis.

 

Figure 10
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  		Fig. 5A —80-year-old woman with severe calcification. MDCT scan shows severe but circumscribed mitral valve calcification (grade 2) affecting anterior and posterior mitral valve leaflets (arrows).

 

Figure 11
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  		Fig. 5B —80-year-old woman with severe calcification. Corresponding echocardiogram depicts thickening and calcification of mitral valve leaflets (arrows) that are indicative of severe mitral valve stenosis.

 

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