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Aortic Regurgitation: Assessment with 64-Section CT¹

¹ From the Institute of Diagnostic Radiology (H.A., L.D., L.H., S.L., H.S., B.M., T.F.), Clinic for Cardiovascular Surgery (A.P., R.V., M.G.), and Cardiovascular Center (T.S., O.G., R.J., P.A.K.), University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland; Siemens Medical Solutions, Computed Tomography, Forchheim, Germany (T.G.F.); and Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland (P.A.K.). Received September 4, 2006; revision requested November 3; revision received November 15; accepted December 20; final version accepted February 1, 2007. Supported by the National Center of Competence in Research, Computer Aided and Image Guided Medical Interventions of the Swiss National Science Foundation. Address correspondence to H.A. (e-mail: hatem.alkadhi{at}usz.ch).

Purpose: To prospectively evaluate diagnostic accuracy of 64-section computed tomography (CT) for evaluation of aortic regurgitation (AR), with transthoracic echocardiography (TTE) as reference.

Materials and Methods: The institutional review board approved this study; written informed consent was obtained. Thirty patients (23 men, seven women; mean age, 56.6 years) with AR underwent TTE and retrospective electrocardiographically gated 64-section CT. CT data sets were reconstructed in 5% steps from 40% to 90% of R-R interval for analysis. Maximum regurgitant orifice area (ROA) in diastole was planimetrically measured with CT, and measurements were compared with semiquantitative classification with TTE (Spearman rank order correlation coefficients). Receiver operating characteristic (ROC) curves were calculated for differentiation between degrees of AR with ROA measurements. Dimensions of the aortic root and left ventricular parameters were compared (Pearson correlation analysis).

Results: A significant correlation was observed between CT planimetric size of ROA (mean, 62 mm² ± 63 [standard deviation]; range, 6–224 mm²) and TTE classification of mild, moderate, and severe AR (r = 0.84, P < .001). With ROC analysis, discrimination between degrees of AR with CT was highly accurate when cutoff ROAs (25 mm² and 75 mm²) were used. A significant correlation was observed between methods in dimensions of aortic annulus (mean, 29.0 mm ± 4.6), sinus of Valsalva (mean, 38.3 mm ± 8.6), and ascending aorta (mean, 37.2 mm ± 8.0); mean values were 27.4 mm ± 4.9 (r = 0.76, P < .001), 37.7 mm ± 8.6 (r = 0.94, P < .001), and 38.2 mm ± 7.9 (r = 0.96, P < .001), respectively. Mean end-systolic volume (67 mL ± 38), end-diastolic volume (149 mL ± 48), and ejection fraction (57% ± 13) at CT correlated well with mean results at TTE (65 mL ± 36 [r = 0.96, P < .001], 140 mL ± 48 [r = 0.91, P < .001], 56% ± 13 [r = 0.98, P < .001], respectively).

Conclusion: Results of assessment of AR with 64-section CT are similar to those with TTE.

© RSNA, 2007

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