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DOI:10.2214/AJR.04.1463
AJR 2006; 186:350-360
© American Roentgen Ray Society

Pictorial Essay

MDCT Evaluation of Aortic Valvular Disease

Robert C. Gilkeson1, Alan H. Markowitz2, Amit Balgude1 and Peter B. Sachs1

1 Department of Radiology, University Hospitals of Cleveland and Case Medical School, 11100 Euclid Ave., Cleveland, OH 44106-5000.
2 Department of Cardiothoracic Surgery, University Hospitals of Cleveland and Case Medical School, Cleveland, OH 44106-5000.

Received October 7, 2004; accepted after revision January 31, 2005.

 
Address correspondence to R. C. Gilkeson (gilkeson{at}uhrad.com).


Abstract
Top
 Abstract
Introduction
 Imaging Protocol
 Conclusion
 References
 
OBJECTIVE. This essay depicts recent advances of MDCT in the evaluation of aortic valvular disease.

CONCLUSION. Aortic valvular disease can be assessed with current MDCT technology. The improved imaging characteristics of MDCT have significantly decreased artifacts traditionally seen with prosthetic aortic valves and enabled excellent visualization of valve function. Advances in ECG-gated MDCT technology offer the opportunity to evaluate a variety of aortic valvular abnormalities.

Keywords: aorta • cardiac imaging • cardiovascular imaging • MDCT


Introduction
Top
 Abstract
 Introduction
Imaging Protocol
 Conclusion
 References
 
As our population ages, the incidence and complexity of aortic valvular disease increase. Although advances in drug therapies and increasingly sophisticated stenting procedures have decreased the rates for coronary artery bypass surgery, aortic valve surgical procedures have increased. This growing population of patients offers a significant opportunity for a more sophisticated approach to imaging of the aortic valve. The development of MDCT has revolutionized cardiac imaging. Advances in ECG-gated MDCT technology offer the opportunity to evaluate a variety of aortic valvular abnormalities [1]. This essay depicts recent advances of MDCT in the evaluation of aortic valvular disease.


Imaging Protocol
Top
 Abstract
 Introduction
 Imaging Protocol
Conclusion
 References
 
When there is a question of aortic valvular disease at our institution, studies are performed on a 16-MDCT scanner (MX IDT, Philips Medical Systems). To optimize CT evaluation of the aortic valve, close attention to both image acquisition and postprocessing techniques is essential. When there is a question of aortic valvular disease at our institution, retrospective ECG-gating is used. Visualization of the aortic valve can be limited in patients with high heart rates (> 80 beats per minute [bpm]) and significant arrhythmias, and the often urgent nature of aortic disease can preclude the routine use of ß-blockers. In the nonemergent patient, beta blockade is helpful when heart rates are over 70 bpm.

Scanning protocols are dependent on the clinical information. If the entire thoracic aorta is to be imaged, a slice collimation of 2.0 mm with a 1.0-mm overlap is used. When a more detailed evaluation of the aortic valve and coronary arteries is needed, a slice thickness of 1.0 mm is used. With ECG-gated scans, pitch values of 0.3-0.375 are generally used, with CT technique parameters between 120 and 140 kV and 350-400 mAs. Optimization of aortic valve and coronary artery anatomy is achieved with a bolus-tracking device and the region of interest placed within the aortic root; 100-125 mL of nonionic contrast material is injected followed by a saline flush at a rate of 4 mL/sec. The patient is scanned in the cephalocaudad direction. Retrospective ECG-gated images are reconstructed sequentially at every 12.5% of the R-R interval.

Targeted evaluation of the aortic valve is performed on a dedicated workstation. Computer software enables review in anatomically appropriate multiplanar reconstruction planes, and aortic valve motion is reviewed in the cine mode (Figs. 1A, 1B, 1C, and 1D). Virtual endoscopy of the aortic valve is performed and reviewed in both volume and surface-shaded settings. Virtual endoscopic views of the closed valve are obtained on images obtained at 75% of the R-R interval, the optimal diastolic phase when the valve is closed and free of motion artifacts.


Figure 1
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  		Fig. 1A —Optimal imaging planes for evaluation of aortic valve shown in 34-year-old man. Coronal multiplanar reconstruction view shows aortic valve with imaging plane localizer (lines) in axial oblique plane.

 

Figure 2
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  		Fig. 1B —Optimal imaging planes for evaluation of aortic valve shown in 34-year-old man. Oblique axial image depicts aortic valve. R = right coronary sinus, L = left coronary sinus, N = noncoronary cusp.

 

Figure 3
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  		Fig. 1C —Optimal imaging planes for evaluation of aortic valve shown in 34-year-old man. Cine CT image of aortic valve in axial oblique plane, beginning in end-diastole. Single frame shows appearance of valve leaflets in end-systole (arrows). On dynamic images, which are available online (www.ajronline.org), note opening of valve leaflets with symmetric effacement of aortic valve during systole and complete closure with diastole.

 

Figure 4
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  		Fig. 1D —Optimal imaging planes for evaluation of aortic valve shown in 34-year-old man. Cine CT image of aortic valve in coronal plane. Single frame shows complete coaptation of aortic valve (arrow) in diastole. On dynamic images available online (www.ajronline.org), note symmetric opening of valve leaflets during cardiac cycle.

 
The Normal Aortic Valve
The aortic valve apparatus consists of the aortic valve cusps, aortic sinuses, commissures, and coronary artery ostia. Multiplanar reconstructions of the aorta are performed to obtain these views. From a coronal multiplanar reconstruction (Fig. 1A), an oblique axial view of the aortic valve is generated. In this optimal oblique axial imaging plane, the three aortic valve sinuses are well defined (Fig. 1B). In the cine mode, the aortic valve leaflets open and close symmetrically. During systole, the aortic valve opens and there is symmetric effacement of the aortic sinuses (Fig. 1C). In the coronal plane, coaptation of the valve leaflets is evaluated (Fig. 1D). Virtual endoscopic views can enable a more accurate presurgical evaluation of the aortic valve (Fig. 2). The improved imaging characteristics of MDCT have significantly decreased artifacts traditionally seen with prosthetic aortic valves and have enabled excellent visualization of valve function (Figs. 3A, 3B, 3C, and 3D).


Figure 5
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  		Fig. 2 —42-year-old man who presented for evaluation of arrhythmias. Virtual endoscopic image shows volume-rendered views of aortic valve during end-diastole. Arrows denote valve leaflets and asterisks, aortic sinuses.

 

Figure 6
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  		Fig. 3A —28-year-old woman with Marfan syndrome who presented for evaluation of status after undergoing St. Jude aortic valve replacement. Coronal multiplanar reconstruction cine image of normal prosthetic valve motion. Single frame shows symmetric opening of prosthetic components (arrow). Prosthetic valve is intact. Dynamic images available online (www.ajronline.org) show complete coaptation of valvular components in diastole.

 

Figure 7
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  		Fig. 3B —28-year-old woman with Marfan syndrome who presented for evaluation of status after undergoing St. Jude aortic valve replacement. Oblique sagittal multiplanar reconstruction cine image of normal St. Jude's prosthetic valve. Single frame shows symmetric opening of prosthetic components (arrow). Dynamic images available online (www.ajronline.org) show symmetric opening of prosthetic valve leaflets in systole in view of left ventricle outflow tract.

 

Figure 8
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  		Fig. 3C —28-year-old woman with Marfan syndrome who presented for evaluation of status after undergoing St. Jude aortic valve replacement. Virtual endoscopic images show prosthetic valve in diastole (C) and in systole (D). Note origins of reimplanted coronary arteries (arrows).

 

Figure 9
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  		Fig. 3D —28-year-old woman with Marfan syndrome who presented for evaluation of status after undergoing St. Jude aortic valve replacement. Virtual endoscopic images show prosthetic valve in diastole (C) and in systole (D). Note origins of reimplanted coronary arteries (arrows).

 


Figure 10
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  		Fig. 4A —38-year-old man who presented with chest pain and widened mediastinum. Oblique axial cine image shows aortic valve. Single frame shows appearance of classic bicuspid valve (arrow). Note symmetric opening of right and left aortic cusps during cardiac cycle.

 


Figure 11
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  		Fig. 4B —38-year-old man who presented with chest pain and widened mediastinum. Virtual endoscopic view of aorta in systole shows symmetric appearance of bicuspid valve with ellipsoid configuration of open valve (arrow).

 
Congenital Anomalies of the Aortic Valve
The most important congenital anomaly of the aortic valve is the bicuspid valve, which affects 0.5-1% of the population [2]. The classical bicuspid valve shows two symmetric aortic cusps. During diastole, the open bicuspid aortic valve assumes an ellipsoid shape (Figs. 4A and 4B). In the aging patient with a bicuspid aortic valve, the effective valve area gradually decreases (Figs. 5A and 5B). On cine CT, the precise architecture of the valves and their patterns of commissural fusion can be identified (Fig. 6). In the evaluation of patients with suspected bicuspid valves that require valve repair, several anatomic issues must be addressed for presurgical planning. The degree of calcification of the valve is important in determining the need for coronary artery implantation. If the calcification is significant (Fig. 7), coronary reimplantation and aortic root replacement may be indicated [3].


Figure 12
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  		Fig. 5A —78-year-old woman with aortic stenosis. Oblique axial CT image of aortic valve shows slightly thickened, markedly stenotic bicuspid valve (arrow) in systole.

 

Figure 13
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  		Fig. 5B —78-year-old woman with aortic stenosis. Corresponding virtual endoscopic view of aortic valve in systole. Arrow denotes thickened valve leaflets, and arrowhead shows associated valvular calcification.

 

Figure 14
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  		Fig. 6 —58-year-old man with aortic valve stenosis. Cine image shows moderately stenotic bicuspid aortic valve. Single frame shows thickened valve leaflets (arrow) and partial fusion of left and right coronary cusps (asterisk). Dynamic images available online (www.ajronline.org) confirm limited excursion of bicuspid valve leaflets.

 

Figure 15
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  		Fig. 7 —78-year-old woman with history of calcific aortic stenosis. Virtual endoscopic view shows heavily calcified valve. While left coronary artery orifice (arrow) is visualized, right coronary artery orifice is obscured by heavy calcification.

 


Figure 16
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  		Fig. 8A —60-year-old woman with chest pain. Oblique axial image of aortic valve shows large sinus of Valsalva aneurysm (arrow) arising from noncoronary cusp.

 


Figure 17
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  		Fig. 8B —60-year-old woman with chest pain. Oblique axial image of aortic valve shows interval thrombosis of sinus of Valsalva aneurysm (arrow) after surgical exclusion.

 


Figure 18
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  		Fig. 9 —72-year-old woman with echocardiographic evidence of severe aortic stenosis. Oblique axial image shows extensive aortic valve calcification (arrow), consistent with degenerative aortic stenosis.

 
Small but significant sinus of Valsalva aneurysms have been reported in the literature. Although sinus of Valsalva aneurysms have been associated with trauma and infective endocarditis, a congenital cause is commonly identified in the literature [4]. Included as a rare cause of a mediastinal or paracardiac mass, sinus of Valsalva aneurysms can present with chest pain, conduction abnormalities, and aortic insufficiency [5]. Involvement of the noncoronary cusp with extension to the interatrial septum is most common. These aneurysms and their postoperative appearance are well characterized with CT, and CT allows precise delineation and depiction of aortic valve function after surgical repair (Figs. 8A and 8B).

Acquired Abnormalities
A significant patient population is living into their late 70s, 80s, and 90s with degenerative calcific aortic stenosis. Accurate assessment of aortic valve gradients based on aortic calcification can be performed in the absence of ECG gating (Fig. 9), and these studies show excellent correlation of the aortic calcium score with the degree of valvular stenosis [6]. Using retrospective ECG gating, these studies also show accurate architectural delineation of the aortic valve. Advanced imaging applications enable 3D depiction of the stenotic aortic valve. Although aortic stenosis can be assessed with ECG-gated CT (Figs. 10A and 10B), the insufficient aortic valve can be assessed with CT when a lack of valve closure is documented in the diastolic phase (Fig. 11).


Figure 19
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  		Fig. 10A —70-year-old man with aortic stenosis by echocardiography. Coronal cine CT image shows thickened, calcified degenerative aortic valve. Single-frame image shows updoming of valve leaflets and stenosis of aortic valve orifice (arrow). Dynamic images available online (www.ajronline.org) confirm valve stenosis and illustrate associated left ventricular hypertrophy.

 

Figure 20
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  		Fig. 10B —70-year-old man with aortic stenosis by echocardiography. Oblique axial cine CT image of aortic valve. Single frame shows thickened and stenotic aortic valve (arrow). Comparison of dynamic images available online (www.ajronline.org) with Figure 10C, also available online, illustrates markedly compromised valve opening.

 

Figure 21
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  		Fig. 11 —52-year-old man with history of Marfan syndrome. Coronal multiplanar reconstruction cine image shows aortic insufficiency. Single frame shows lack of coaptation of aortic valves during diastole (arrow). Findings depicted on dynamic images of aortic insufficiency, which are available online (www.ajronline.org), correlated with findings at echocardiography.

 

The superior imaging capabilities of MDCT in the evaluation of aortic dissection have been described in the literature [7]. With the use of ECG gating and cine evaluation, the relationship of the dissection flap to the aortic valve is well depicted (Figs. 12A, 12B, and 12C). This cine CT capability is especially important in assessing involvement of the coronary arteries, because involvement of the coronary arteries necessitates reimplantation of the coronary arteries in addition to dissection repair (Figs. 13A and 13B).


Figure 22
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  		Fig. 12A —72-year-old woman with suspected type A dissection. Coronal multiplanar reconstruction image shows complex type A dissection. Although flap (arrow) is discontinuous in mid ascending aorta, there is extension of dissection into aortic root (arrowhead).

 

Figure 23
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  		Fig. 12B —72-year-old woman with suspected type A dissection. Cine evaluation at aortic valve plane. Single frame reveals that dissection (arrow) extends into noncoronary cusp. Dynamic images available online (www.ajronline.org) show involvement of noncoronary cusp with preservation of valve function.

 

Figure 24
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  		Fig. 12C —72-year-old woman with suspected type A dissection. Virtual endoscopic view shows fenestrated dissection flap (arrow) with extension into noncoronary cusp.

 

Figure 25
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  		Fig. 13A —57-year-old man with chest pain and pulmonary edema. Sagittal oblique cine imaging of aortic valve. Single frame shows dissection flap (arrows) within proximal ascending aorta. Dynamic views available online (www.ajronline.org) show dissection flap prolapsing through aortic valve in diastole.

 

Figure 26
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  		Fig. 13B —57-year-old man with chest pain and pulmonary edema. Coronal cine image. Single-frame image defines relationship of dissection flap to left coronary artery (arrow). Dynamic images available online (www.ajronline.org) confirm intermittent obstruction of left coronary artery and prolapse through aortic valve.

 

Aortic valve endocarditis is a problematic clinical diagnosis. The classic presentation is fever, congestive heart failure, renal failure, and systemic embolic events [8]. Although the early literature described a sensitivity of only 50% [9], echocardiography improved sensitivity to 80%. MRI evaluation of aortic valve infection is less well characterized; usually abnormalities of perivalvular abscesses and fluid collections have been described [10]. This has been true of the CT literature, in which scattered case reports have described depiction of perivalvular fluid collections as a manifestation of valve infection [11]. With the superior resolution of 16-MDCT and ECG gating, visualization of aortic valve vegetations is possible and, in some cases, has been superior to echocardiographic visualization (Figs. 14A and 14B). Advanced tissue segmentation techniques allow sophisticated presentation of these cases (Figs. 15A, 15B, and 15C).


Figure 27
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  		Fig. 14A —35-year-old man with fever and bacteremia 2 years after stentless aortic valve replacement. Axial oblique cine image of aortic valve. Single frame shows vegetation (arrow) in region of right coronary cusp. Dynamic images available online (www.ajronline.org) confirm mobile vegetation is occupying right aortic sinus.

 

Figure 28
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  		Fig. 14B —35-year-old man with fever and bacteremia 2 years after stentless aortic valve replacement. Virtual endoscopic view of aortic valve shows vegetation (arrow) within right coronary sinus. Cardiac surgery reconfirmed periaortic valve abscess and valvular vegetations.

 

Figure 29
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  		Fig. 15A —45-year-old woman with history of systemic lupus erythematosus and clinical evidence of peripheral arterial emboli. Axial oblique ECG-gated view of aortic valve in diastole shows well-defined soft-tissue mass (arrow) on aortic valve.

 

Figure 30
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  		Fig. 15B —45-year-old woman with history of systemic lupus erythematosus and clinical evidence of peripheral arterial emboli. Coronal multiplanar reconstruction view confirms well-defined soft-tissue vegetation (arrow) on aortic valve.

 

Figure 31
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  		Fig. 15C —45-year-old woman with history of systemic lupus erythematosus and clinical evidence of peripheral arterial emboli. Surface-shaded virtual endoscopy with tissue segmentation shows endoscopic view of this vegetation (arrow) in relation to right and left coronary cusp, which at surgery was consistent with Libman-Sacks endocarditis.

 

Inflammatory aortitis usually presents with aortic and great vessel wall thickening and is often complicated by aneurysms or pseudoaneurysms. Takayasu's arteritis is a large-vessel vasculitis that classically affects young Asian women. While often characterized by obstruction and stenosis of the great vessels, the inflammation can result in weakening of the aortic annulus and subsequent valve insufficiency [12]. Though an uncommon entity, inflammatory aortitis should be considered in patients presenting with aortic insufficiency (Fig. 16).


Figure 32
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  		Fig. 16 —21-year-old woman with Takayasu's arteritis, chest pain, and widened mediastinum. Oblique axial image shows dilation of aortic root with dilation of involved aortic sinuses (arrow).

 

Conclusion
Top
 Abstract
 Introduction
 Imaging Protocol
 Conclusion
References
 
This article has described the imaging advances of ECG-gated MDCT in the evaluation of aortic valvular disease. Once thought to be the domain of echocardiography and MRI, aortic valvular disease can often be assessed with current MDCT technology. Further research in dynamic imaging and advances in contrast agents may provide the physiologic measurements of flow and transvalvular gradients not possible with our existing technology. These innovations will strengthen the already growing role CT has defined in the evaluation of aortic valvular disease.


References
Top
 Abstract
 Introduction
 Imaging Protocol
 Conclusion
 References
 

  1. Morgan-Hughes GJ, Roobottom CA, Marshal AJ. Electrocardiographic gated multislice computed tomography of the thoracic aorta. Heart 2003; 89:838[Free Full Text]
  2. Basso C, Boschello M, Perrone C, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol 2004; 93:661 -663[CrossRef][Medline]
  3. Markowitz A. Utility of the full root bioprosthesis in surgery for complex aortic valve-ascending aortic disease. Semin Thorac Cardiovasc Surg 2001;13 [suppl 1]: 12-15[Medline]
  4. Lin CY, Hong GJ, Lee KC, Tsai YT, Tsai CS. Ruptured congenital sinus of Valsalva aneurysms. J Card Surg2004; 19:99 -102[Medline]
  5. Moukarbel GV, Abchee AB. Severe aortic insufficiency in a patient with sinus of Valsalva aneurysm invading the interventricular septum. Heart 2004; 90:1470[Free Full Text]
  6. Cowell SJ, Newby DE, Burton J, et al. Aortic valve calcification on computed tomography predicts the severity of aortic stenosis. Clin Radiol 2003; 58:712 -716[CrossRef][Medline]
  7. Cademartiri F, Nieman K, Mollet NR. The dynamics of an ascending aorta dissection by 16 row multislice computed tomography. Heart 2003; 89:970[Free Full Text]
  8. Kim JH, Wiseman A, Kisslo J, Durack DT. Echocardiographic detection and clinical significance of left atrial vegetation in active infective endocarditis. Am J Cardiol 1989;64 : 950-952[Medline]
  9. Von Reyn CF, Levy BS, Arbeit RD, Friedland G, Crumpacker CS. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med 1981;94 (4 pt 1):505 -518[Medline]
  10. Jeang MK, Fuentes F, Gately A, Byrnes J, Lewis M. Aortic root abscess: initial experience using magnetic resonance imaging. Chest 1986; 89:613 -615[Abstract/Free Full Text]
  11. Cowan JC, Patrick D, Reid DS. Aortic root abscess complicating bacterial endocarditis: demonstration by computed tomography. Br Heart J 1984; 52:591 -593[Abstract/Free Full Text]
  12. Matsunaga N, Hayashi K, Sakamoto I, Ogawa Y, Matsumoto T. Takayasu arteritis: protean radiologic manifestations and diagnosis. RadioGraphics 1997;17 : 579-594[Abstract]

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