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Sixty-Four Slice CT Evaluation of Aortic Stenosis Using Planimetry of the Aortic Valve Area

¹ Clinical Department of Radiology II, Innsbruck Medical University, Anichstrasse 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.
⁴ Clinical Department of Anesthesia and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —64-slice CT of coronary arteries in 75-year-old man. MDCT allows simultaneous evaluation of coronary arteries (A) and aortic valve (B), shown in 3D by applying volume-rendering technique. Note that severe calcification (white spots) of both aortic valve and coronary arteries is frequently seen. LCA = left coronary artery, RCA = right coronary artery.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —64-slice CT of coronary arteries in 75-year-old man. MDCT allows simultaneous evaluation of coronary arteries (A) and aortic valve (B), shown in 3D by applying volume-rendering technique. Note that severe calcification (white spots) of both aortic valve and coronary arteries is frequently seen. LCA = left coronary artery, RCA = right coronary artery.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Planimetry of aortic valve area (AVA) performed after identifying maximal aortic valve opening using 4D dynamic imaging (see Fig. S1, cine CT, at www.ajronline.org). MDCT images show tricuspid valve in 79-year-old woman with moderate aortic stenosis (aortic valve area, 1.1 cm2) (A and C) and bicuspid valve in 53-year-old-man with severe aortic stenosis (aortic valve area, 0.98 cm2) (B and D). A and B were reconstructed with multiplanar reformations, C and D with volume rendering using 1-mm slab.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Planimetry of aortic valve area (AVA) performed after identifying maximal aortic valve opening using 4D dynamic imaging (see Fig. S1, cine CT, at www.ajronline.org). MDCT images show tricuspid valve in 79-year-old woman with moderate aortic stenosis (aortic valve area, 1.1 cm2) (A and C) and bicuspid valve in 53-year-old-man with severe aortic stenosis (aortic valve area, 0.98 cm2) (B and D). A and B were reconstructed with multiplanar reformations, C and D with volume rendering using 1-mm slab.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Planimetry of aortic valve area (AVA) performed after identifying maximal aortic valve opening using 4D dynamic imaging (see Fig. S1, cine CT, at www.ajronline.org). MDCT images show tricuspid valve in 79-year-old woman with moderate aortic stenosis (aortic valve area, 1.1 cm2) (A and C) and bicuspid valve in 53-year-old-man with severe aortic stenosis (aortic valve area, 0.98 cm2) (B and D). A and B were reconstructed with multiplanar reformations, C and D with volume rendering using 1-mm slab.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Planimetry of aortic valve area (AVA) performed after identifying maximal aortic valve opening using 4D dynamic imaging (see Fig. S1, cine CT, at www.ajronline.org). MDCT images show tricuspid valve in 79-year-old woman with moderate aortic stenosis (aortic valve area, 1.1 cm2) (A and C) and bicuspid valve in 53-year-old-man with severe aortic stenosis (aortic valve area, 0.98 cm2) (B and D). A and B were reconstructed with multiplanar reformations, C and D with volume rendering using 1-mm slab.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Planimetry of aortic valve area with 64-slice CT versus transthoracic echocardiography (TTE) using continuity equation for calculation of aortic valve area (in cm2) with Doppler velocity-time integral in 32 patients. Linear regression analysis illustrates good correlation between both imaging techniques.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Planimetry of aortic valve area with 64-slice CT versus transthoracic echocardiography (TTE) using continuity equation for calculation of aortic valve area (in cm2) with Doppler velocity-time integral in 32 patients. Bland-Altman plot implies good intertechnique agreement.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Planimetry of aortic valve area with 64-slice CT versus transthoracic echocardiography (TTE) using continuity equation for calculation of aortic valve area (in cm2) with Doppler velocity-time integral in 32 patients. Planimetry of aortic valve area with CT versus TEE (n = 10) shows high concordance on Bland-Altman plot.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Planimetry of aortic valve area with CT versus transthoracic echocardiography (TTE). Planimetry of aortic valve area on CT versus mean (A) and maximum (B) transvalvular pressure gradients on TTE show moderate correlation.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Planimetry of aortic valve area with CT versus transthoracic echocardiography (TTE). Planimetry of aortic valve area on CT versus mean (A) and maximum (B) transvalvular pressure gradients on TTE show moderate correlation.

View larger version (174K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Planimetry of aortic valve areas (AVA) in different shapes. Normal aortic valve (area, 3.2 cm2) in 53-year-old woman.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Planimetry of aortic valve areas (AVA) in different shapes. Stenotic triangular aortic valve (area, 0.81 cm2) in 70-year-old man with severe aortic stenosis and severe calcification (white spots) of tricuspid valve.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Planimetry of aortic valve areas (AVA) in different shapes. Slotlike appearance of aortic valve (area, 0.67 cm2) in 79-year-old woman with severe aortic stenosis and bicuspid valve.

View larger version (85K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —Planimetry of aortic valve areas (AVA) in different shapes. Spotlike aortic valve (area, 0.55 cm2) in 66-year-old woman with symptomatic, critical severe aortic stenosis of functional bicuspid valve in whom surgery is indicated.

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