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64-MDCT for Diagnosis of Aortic Regurgitation in Patients Referred to CT Coronary Angiography

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.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Severe aortic regurgitation in 58-year-old man referred to coronary CT angiography. CT image, 3D volume-rendering technique reconstruction, shows evaluation of coronary arteries before surgery.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Severe aortic regurgitation in 58-year-old man referred to coronary CT angiography. Photograph obtained during surgery shows intraoperative specimen of tricuspid aortic valve without calcification.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Severe aortic regurgitation in 58-year-old man referred to coronary CT angiography. CT image shows incomplete coadaptation of aortic valve leaflets (red arrow). A = aorta, M = mitral valve.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Severe aortic regurgitation in 58-year-old man referred to coronary CT angiography. CT image shows triangular central aortic regurgitation area (ARA) of this tricuspid valve was measured on cross-sectional transverse plane. ARA = 0.76 cm2.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —Severe aortic regurgitation in 58-year-old man referred to coronary CT angiography. Transthoracic echocardiography confirms severe aortic valve regurgitation by showing diastolic Doppler regurgitation with proximal jet width of 8.8 mm.

View larger version (181K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Moderate aortic regurgitation in asymptomatic 67-year-old man referred to coronary CT angiography for exclusion of coronary artery disease before orthopedic surgery because of inconclusive treadmill ECG stress test and high coronary risk profile. Previous echocardiography (outpatient) was interpreted as normal, but reevaluation by echocardiography in our institution revealed moderate aortic valve regurgitation, grade 2. Left sagittal oblique image shows incomplete coadaptation of leaflets (arrows). Inset shows corresponding transverse image of aortic valve with central regurgitation area (R in inset) of 0.46 cm2.

View larger version (81K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Moderate aortic regurgitation in asymptomatic 67-year-old man referred to coronary CT angiography for exclusion of coronary artery disease before orthopedic surgery because of inconclusive treadmill ECG stress test and high coronary risk profile. Previous echocardiography (outpatient) was interpreted as normal, but reevaluation by echocardiography in our institution revealed moderate aortic valve regurgitation, grade 2. Echocardiography shows reduced pressure half-time of 295 milliseconds indicating moderate aortic valve regurgitation.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Mild aortic regurgitation previously unknown in 67-year-old woman referred to coronary CT angiography. Left coronal oblique CT image shows incomplete closure of valve leaflets (arrow) that appear as tiny spotlike regurgitation area.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Mild aortic regurgitation previously unknown in 67-year-old woman referred to coronary CT angiography. Cross-sectional axial CT image shows regurgitation area (arrow). Image postprocessing was performed using multiplanar reformations.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Severe valve calcification, false-negative for aortic regurgitation, in 55-year-old woman. Left coronal oblique plane (A) and left sagittal oblique plane (B) were used to reconstruct perpendicular cross-sectional image (C) of aortic valve by applying multiplanar reformations. Note that very tiny white "spot" is seen centrally within thickened leaflets; this finding indicates mild aortic valve regurgitation, which was missed initially by CT but could be retrospectively detected.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Severe valve calcification, false-negative for aortic regurgitation, in 55-year-old woman. Left coronal oblique plane (A) and left sagittal oblique plane (B) were used to reconstruct perpendicular cross-sectional image (C) of aortic valve by applying multiplanar reformations. Note that very tiny white "spot" is seen centrally within thickened leaflets; this finding indicates mild aortic valve regurgitation, which was missed initially by CT but could be retrospectively detected.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Severe valve calcification, false-negative for aortic regurgitation, in 55-year-old woman. Left coronal oblique plane (A) and left sagittal oblique plane (B) were used to reconstruct perpendicular cross-sectional image (C) of aortic valve by applying multiplanar reformations. Note that very tiny white "spot" is seen centrally within thickened leaflets; this finding indicates mild aortic valve regurgitation, which was missed initially by CT but could be retrospectively detected.

View larger version (56K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Bicuspid valve (false-negative) in 52-year-old man with ascending aortic aneurysm (6.1 cm) in whom mild aortic regurgitation was missed on CT because no central valvular leakage area (arrow) was visible. AA = ascending aorta, LAD = left anterior descending coronary artery, RCA = right coronary artery.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —Box plot illustrates distribution of central aortic regurgitation area (ARA) measurement values by CT in patients with mild, moderate, and severe aortic regurgitation (grades 1–3, respectively, as shown on x-axis) by transthoracic echocardiography. Note that there was no significant overlap of ARA data between grades 1–3, which indicates promising potential of CT to quantify severity of aortic valve regurgitation based on ARA. Whiskers show ranges of values, shaded boxes mark mean ± 1 SD, thick lines show mean values, and circles indicate extreme values.

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