Abstract
Cardiac computed tomography (CT) produces high-quality anatomical images of the cardiac valves and associated structures. Cardiac magnetic resonance imaging (MRI) provides images of valve morphology, and allows quantitative evaluation of valvular dysfunction and determination of the impact of valvular lesions on cardiovascular structures. Recent studies have demonstrated that cardiac CT and MRI are important adjuncts to echocardiography for the evaluation of aortic and mitral valvular heart diseases (VHDs). Radiologists should be aware of the technical aspects of cardiac CT and MRI that allow comprehensive assessment of aortic and mitral VHDs, as well as the typical imaging features of common and important aortic and mitral VHDs on cardiac CT and MRI.
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- AF:
-
Atrial fibrillation
- AR:
-
Aortic regurgitation
- AS:
-
Aortic stenosis
- AVA:
-
Aortic valve area
- BAV:
-
Bicuspid aortic valve
- CAD:
-
Coronary artery disease
- CT:
-
Computed tomography
- D:
-
Dimensional
- ECG:
-
Electrocardiography
- IE:
-
Infective endocarditis
- LV:
-
Left ventricular
- MDCT:
-
Multidetector computed tomography
- MR:
-
Mitral regurgitation
- MRI:
-
Magnetic resonance imaging
- MS:
-
Mitral stenosis
- MVA:
-
Mitral valve area
- RF:
-
Regurgitant fraction
- ROA:
-
Regurgitant orifice area
- SSFP:
-
Steady-state free precession
- TAV:
-
Tricuspid aortic valve
- TTE:
-
Transthoracic echocardiography
- VHD:
-
Valvular heart disease
References
Rosamond W, Flegal K, Furie K et al (2008) Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 117(4):e25–e146
Lung B, Baron G, Butchart EF et al (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J 24(13):1231–1243
Cicioni C, Di Luzio V, Di Emidio L et al (2006) Limitations and discrepancies of transthoracic and transoesophageal echocardiography compared with surgical findings in patients submitted to surgery for complications of infective endocarditis. J Cardiovasc Med (Hagerstown) 7(9):660–666
Ketelsen D, Fishman EK, Claussen CD, Vogel-Claussen J (2010) Computed tomography evaluation of cardiac valves: a review. Radiol Clin N Am 48(4):783–797
Cawley PJ, Maki JH, Otto CM (2009) Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Circulation 119(3):468–478
Christiansen JP, Karamitsos TD, Myerson SG (2011) Assessment of valvular heart disease by cardiovascular magnetic resonance imaging: a review. Heart Lung Circ 20(2):73–82
Bettencourt N, Rocha J, Carvalho M et al (2009) Multislice computed tomography in the exclusion of coronary artery disease in patients with presurgical valve disease. Circ Cardiovasc Imaging 2(4):306–313
Feuchtner GM, Muller S, Bonatti J et al (2007) Sixty-four slice CT evaluation of aortic stenosis using planimetry of the aortic valve area. AJR Am J Roentgenol 189(1):197–203
Jassal DS, Shapiro MD, Neilan TG et al (2007) 64-slice multidetector computed tomography (MDCT) for detection of aortic regurgitation and quantification of severity. Invest Radiol 42(7):507–512
Li X, Tang L, Zhou L et al (2009) Aortic valves stenosis and regurgitation: assessment with dual source computed tomography. Int J Cardiovasc Imaging 25(6):591–600
Vogel-Claussen J, Pannu H, Spevak PJ et al (2006) Cardiac valve assessment with MR imaging and 64-section multi-detector row CT. Radiographics 26(6):1769–1784
LaBounty TM, Sundaram B, Agarwal P et al (2008) Aortic valve area on 64-MDCT correlates with transesophageal echocardiography in aortic stenosis. AJR Am J Roentgenol 191(6):1652–1658
Feuchtner GM, Dichtl W, Muller S et al (2008) 64-MDCT for diagnosis of aortic regurgitation in patients referred to CT coronary angiography. AJR Am J Roentgenol 191(1):W1–W7
Lembcke A, Durmus T, Westermann Y et al (2011) Assessment of mitral valve stenosis by helical MDCT: comparison with transthoracic Doppler echocardiography and cardiac catheterization. AJR Am J Roentgenol 197(3):614–622
Alkadhi H, Wildermuth S, Bettex DA et al (2006) Mitral regurgitation: quantification with 16-detector row CT-initial experience. Radiology 238(2):454–463
Didier D, Ratib O, Lerch R, Friedli B (2000) Detection and quantification of valvular heart disease with dynamic cardiac MR imaging. Radiographics 20(5):1279–1299 Discussion 1299–1301
Lotz J, Meier C, Leppert A, Galanski M (2002) Cardiovascular flow measurement with phase-contrast MR imaging: basic facts and implementation. Radiographics 22(3):651–671
Taylor AJ, Cerqueira M, Hodgson JM et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 56(22):1864–1894
Hausleiter J, Meyer T, Hermann F et al (2009) Estimated radiation dose associated with cardiac CT angiography. JAMA 301(5):500–507
Mehra VC, Valdiviezo C, Arbab-Zadeh A et al (2011) A stepwise approach to the visual interpretation of CT-based myocardial perfusion. J Cardiovasc Comput Tomogr 5(6):357–369
Hendel RC, Patel MR, Kramer CM et al (2006) ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 48(7):1475–1497
Myerson SG (2009) Valvular and hemodynamic assessment with CMR. Heart Fail Clin 5(3):389–400
Masci PG, Dymarkowski S, Bogaert J (2008) Valvular heart disease: what does cardiovascular MRI add? Eur Radiol 18(2):197–208
Pollak Y, Comeau CR, Wolff SD (2002) Staphylococcus aureus endocarditis of the aortic valve diagnosed on MR imaging. AJR Am J Roentgenol 179(6):1647
Alkadhi H, Leschka S, Trindade PT et al (2010) Cardiac CT for the differentiation of bicuspid and tricuspid aortic valves: comparison with echocardiography and surgery. AJR Am J Roentgenol 195(4):900–908
Chun EJ, Choi SI, Lim C et al (2008) Aortic stenosis: evaluation with multidetector CT angiography and MR imaging. Korean J Radiol 9(5):439–448
Gleeson TG, Mwangi I, Horgan SJ et al (2008) Steady-state free-precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves. J Magn Reson Imaging 28(4):873–878
Bonow RO, Carabello BA, Chatterjee K et al (2008) 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 118(15):e523–e661
Bouvier E, Logeart D, Sablayrolles JL et al (2006) Diagnosis of aortic valvular stenosis by multislice cardiac computed tomography. Eur Heart J 27(24):3033–3038
Kupfahl C, Honold M, Meinhardt G et al (2004) Evaluation of aortic stenosis by cardiovascular magnetic resonance imaging: comparison with established routine clinical techniques. Heart 90(8):893–901
Djavidani B, Debl K, Lenhart M et al (2005) Planimetry of mitral valve stenosis by magnetic resonance imaging. J Am Coll Cardiol 45(12):2048–2053
Lin SJ, Brown PA, Watkins MP et al (2004) Quantification of stenotic mitral valve area with magnetic resonance imaging and comparison with Doppler ultrasound. J Am Coll Cardiol 44(1):133–137
O’Brien KR, Myerson SG, Cowan BR et al (2009) Phase contrast ultrashort TE: a more reliable technique for measurement of high-velocity turbulent stenotic jets. Magn Reson Med 62(3):626–636
Heidenreich PA, Steffens J, Fujita N et al (1995) Evaluation of mitral stenosis with velocity-encoded cine-magnetic resonance imaging. Am J Cardiol 75(5):365–369
Jeon MH, Choe YH, Cho SJ et al (2010) Planimetric measurement of the regurgitant orifice area using multidetector CT for aortic regurgitation: a comparison with the use of echocardiography. Korean J Radiol 11(2):169–177
Alkadhi H, Desbiolles L, Husmann L et al (2007) Aortic regurgitation: assessment with 64-section CT. Radiology 245(1):111–121
Pouleur AC, le Polain de Waroux JB, Pasquet A et al (2007) Planimetric and continuity equation assessment of aortic valve area: head to head comparison between cardiac magnetic resonance and echocardiography. J Magn Reson Imaging 26(6):1436–1443
Goffinet C, Kersten V, Pouleur AC et al (2010) Comprehensive assessment of the severity and mechanism of aortic regurgitation using multidetector CT and MR. Eur Radiol 20(2):326–336
Apostolakis EE, Baikoussis NG (2009) Methods of estimation of mitral valve regurgitation for the cardiac surgeon. J Cardiothorac Surg 4:34
Guo YK, Yang ZG, Ning G et al (2009) Isolated mitral regurgitation: quantitative assessment with 64-section multidetector CT-comparison with MR imaging and echocardiography. Radiology 252(2):369–376
Ley S, Eichhorn J, Ley-Zaporozhan J et al (2007) Evaluation of aortic regurgitation in congenital heart disease: value of MR imaging in comparison to echocardiography. Pediatr Radiol 37(5):426–436
Kutty S, Whitehead KK, Natarajan S et al (2009) Qualitative echocardiographic assessment of aortic valve regurgitation with quantitative cardiac magnetic resonance: a comparative study. Pediatr Cardiol 30(7):971–977
Sechtem U, Pflugfelder PW, Cassidy MM et al (1988) Mitral or aortic regurgitation: quantification of regurgitant volumes with cine MR imaging. Radiology 167(2):425–430
Nigri M, Azevedo CF, Rochitte CE et al (2009) Contrast-enhanced magnetic resonance imaging identifies focal regions of intramyocardial fibrosis in patients with severe aortic valve disease: correlation with quantitative histopathology. Am Heart J 157(2):361–368
Bak SH, Ko SM, Jeon HJ et al (2012) Assessment of global left ventricular function with dual-source computed tomography in patients with valvular heart disease. Acta Radiol 53(3):270–277
Kapa S, Martinez MW, Williamson EE et al (2010) ECG-gated dual-source CT for detection of left atrial appendage thrombus in patients undergoing catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 29(2):75–81
Tadros TM, Klein MD, Shapira OM (2009) Ascending aortic dilatation associated with bicuspid aortic valve: pathophysiology, molecular biology, and clinical implications. Circulation 119(6):880–890
Bandettini WP, Arai AE (2008) Advances in clinical applications of cardiovascular magnetic resonance imaging. Heart 94(11):1485–1495
Williams MC, Reid JH, McKillop G et al (2011) Cardiac and coronary CT comprehensive imaging approach in the assessment of coronary heart disease. Heart 97(15):1198–1205
Chheda SV, Srichai MB, Donnino R et al (2010) Evaluation of the mitral and aortic valves with cardiac CT angiography. J Thorac Imaging 25(1):76–85
Ryan R, Abbara S, Colen RR et al (2008) Cardiac valve disease: spectrum of findings on cardiac 64-MDCT. AJR Am J Roentgenol 190(5):W294–W303
Siu SC, Silversides CK (2010) Bicuspid aortic valve disease. J Am Coll Cardiol 55(25):2789–2800
Joo I, Park EA, Kim KH et al (2012) MDCT differentiation between bicuspid and tricuspid aortic valves in patients with aortic valvular disease: correlation with surgical findings. Int J Cardiovasc Imaging 28(1):171–182
Ferda J, Linhartova K, Kreuzberg B (2008) Comparison of the aortic valve calcium content in the bicuspid and tricuspid stenotic aortic valve using non-enhanced 64-detector-row-computed tomography with prospective ECG-triggering. Eur J Radiol 68(3):471–475
Weidemann F, Herrmann S, Stork S et al (2009) Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation 120(7):577–584
Timperley J, Milner R, Marshall AJ, Gilbert TJ (2002) Quadricuspid aortic valves. Clin Cardiol 25(12):548–552
Morris MF, Maleszewski JJ, Suri RM et al (2010) CT and MR imaging of the mitral valve: radiologic-pathologic correlation. Radiographics 30(6):1603–1620
Feuchtner G, Mueller S, Bonatti J et al (2004) Images in cardiovascular medicine. Prolapsing atrial myxoma: dynamic visualization with multislice computed tomography. Circulation 109(12):e165–e166
Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB (1978) Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 28(10):973–977
Hur J, Kim YJ, Nam JE et al (2008) Thrombus in the left atrial appendage in stroke patients: detection with cardiac CT angiography–a preliminary report. Radiology 249(1):81–87
Hayek E, Gring CN, Griffin BP (2005) Mitral valve prolapse. Lancet 365(9458):507–518
Enriquez-Sarano M, Freeman WK, Tribouilloy CM et al (1999) Functional anatomy of mitral regurgitation: accuracy and outcome implications of transesophageal echocardiography. J Am Coll Cardiol 34(4):1129–1136
Shah RG, Novaro GM, Blandon RJ et al (2010) Mitral valve prolapse: evaluation with ECG-gated cardiac CT angiography. AJR Am J Roentgenol 194(3):579–584
Feuchtner GM, Alkadhi H, Karlo C et al (2010) Cardiac CT angiography for the diagnosis of mitral valve prolapse: comparison with echocardiography1. Radiology 254(2):374–383
Han Y, Peters DC, Salton CJ et al (2008) Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging 1(3):294–303
D’Ancona G, Mamone G, Marrone G et al (2007) Ischemic mitral valve regurgitation: the new challenge for magnetic resonance imaging. Eur J Cardiothorac Surg 32(3):475–480
Stuesse DC, Vlessis AA (1999) Epidemiology of native valve endocarditis. In: Vlesis AA, Bolling S (eds) Endocarditis: a multidisciplinary approach to modern treatment. Futura Publishing Co, Armonk, pp 77–84
Otto CM (2004) Infective endocarditis. In: Otto CM (ed) Valvular heart disease. WB Saunders, Philadelphia, pp 482–521
Feuchtner GM, Stolzmann P, Dichtl W et al (2009) Multislice computed tomography in infective endocarditis: comparison with transesophageal echocardiography and intraoperative findings. J Am Coll Cardiol 53(5):436–444
Aslam AK, Aslam AF, Vasavada BC, Khan IA (2007) Prosthetic heart valves: types and echocardiographic evaluation. Int J Cardiol 122(2):99–110
Kim RJ, Weinsaft JW, Callister TQ, Min JK (2007) Evaluation of prosthetic valve endocarditis by 64-row multidetector computed tomography. Int J Cardiol 120(2):e27–e29
Habets J, Symersky P, van Herwerden LA et al (2011) Prosthetic heart valve assessment with multidetector-row CT: imaging characteristics of 91 valves in 83 patients. Eur Radiol 21(7):1390–1396
Lee DH, Youn HJ, Shim SB et al (2009) The measurment of opening angle and orifice area of a bileaflet mechanical valve using multidetector computed tomography. Korean Circ J 39(4):157–162
Tsai IC, Lin YK, Chang Y et al (2009) Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard. Eur Radiol 19(4):857–867
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This work was supported by KonKuk University in 2012.
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Ko, S.M., Song, M.G. & Hwang, H.K. Evaluation of the aortic and mitral valves with cardiac computed tomography and cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 28 (Suppl 2), 109–127 (2012). https://doi.org/10.1007/s10554-012-0144-z
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DOI: https://doi.org/10.1007/s10554-012-0144-z