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Electrocardiographically Gated Multi–Detector Row CT for Assessment of Valvular Morphology and Calcification in Aortic Stenosis¹

¹ From the Institute of Diagnostic Radiology (J.K.W., D.W., J.E.R., B.M., P.R.H.), Clinic of Cardiovascular Surgery (M.L.), and Clinic of Cardiology (R.K., T.F.L.), University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; and Department of Biostatistics, University of Zurich, Switzerland (B.S.). From the 2001 RSNA scientific assembly. Received October 17, 2001; revision requested January 9, 2002; revision received February 8; accepted March 14. Address correspondence to D.W. (e-mail: dominik.weishaupt@dmr.usz.ch).

View larger version (43K): [in a new window]   Figure 1. Diagrams of different grades of aortic valve calcification. Grade 1 (1), no calcification; grade 2 (2), mild calcification (small isolated spots of calcification); grade 3 (3), moderate calcification (multiple larger spots of calcification); and grade 4 (4), heavy calcification (extensive calcification of all aortic valve leaflets).

View larger version (125K): [in a new window]   Figure 2a. Severe aortic valve stenosis in a 77-year-old patient. (a) Double-oblique reconstruction of contrast-enhanced retrospectively ECG-gated multi-detector row CT data set demonstrates a moderately calcified tricuspid aortic valve (grade 3, multiple larger areas of calcification; large arrows). Image quality was rated as excellent (grade 4, excellent visibility of the anatomic details of the aortic valve, including the aortic valve leaflets [small arrow], free edges of the aortic valve leaflets [black arrowheads], and the aortic valve annulus [white arrowheads]). (b) Intraoperative status of the calcified aortic valve in the same patient. The calcification (large arrows) of the aortic valve was rated as grade 3. Note aortic valve leaflets (small arrow) and free edges of the aortic valve leaflets (arrowheads).

View larger version (132K): [in a new window]   Figure 2b. Severe aortic valve stenosis in a 77-year-old patient. (a) Double-oblique reconstruction of contrast-enhanced retrospectively ECG-gated multi-detector row CT data set demonstrates a moderately calcified tricuspid aortic valve (grade 3, multiple larger areas of calcification; large arrows). Image quality was rated as excellent (grade 4, excellent visibility of the anatomic details of the aortic valve, including the aortic valve leaflets [small arrow], free edges of the aortic valve leaflets [black arrowheads], and the aortic valve annulus [white arrowheads]). (b) Intraoperative status of the calcified aortic valve in the same patient. The calcification (large arrows) of the aortic valve was rated as grade 3. Note aortic valve leaflets (small arrow) and free edges of the aortic valve leaflets (arrowheads).

View larger version (147K): [in a new window]   Figure 3. Moderate aortic valve stenosis in a 73-year-old patient. Double-oblique reconstruction of contrast-enhanced retrospectively ECG-gated multi-detector row CT data set demonstrates a mildly calcified tricuspid aortic valve (grade 2, small isolated spots of calcification; large arrow). Image quality was rated as poor (grade 2, poor visibility of the anatomic details of the aortic valve). The aortic valve leaflets can be appreciated (small arrows), but the free edges of the aortic valve leaflets (black arrowhead) and the aortic valve annulus (white arrowheads) are blurred.

View larger version (145K): [in a new window]   Figure 4. Severe aortic valve stenosis in a 57-year-old patient. Double-oblique reconstruction of contrast-enhanced retrospectively ECG-gated multi-detector row CT data set shows heavily calcified bicuspid aortic valve with large calcific deposit (grade 4, black arrow). The aortic valve leaflets (white arrow) and the aortic valve annulus (arrowheads) are clearly visible. Image quality was rated as good (grade 3, good visibility of the anatomic details of the aortic valve).

View larger version (108K): [in a new window]   Figure 5a. Severe aortic valve stenosis in an 80-year-old patient. Degree of calcification of the tricuspid aortic valve was graded as moderate (grade 3, multiple larger spots of calcification) on both (a) nonenhanced and (b) contrast-enhanced multi-detector row CT images. Image quality was rated as poor (grade 2, poor visibility of the anatomic details of the aortic valve) on a and as good (grade 3, good visibility of the anatomic details of the aortic valve) on b. Note aortic valve calcification (large arrows), aortic valve leaflets (small arrows), free edges of the aortic valve leaflets (black arrowheads on b), and aortic valve annulus (white arrowheads on b).

View larger version (126K): [in a new window]   Figure 5b. Severe aortic valve stenosis in an 80-year-old patient. Degree of calcification of the tricuspid aortic valve was graded as moderate (grade 3, multiple larger spots of calcification) on both (a) nonenhanced and (b) contrast-enhanced multi-detector row CT images. Image quality was rated as poor (grade 2, poor visibility of the anatomic details of the aortic valve) on a and as good (grade 3, good visibility of the anatomic details of the aortic valve) on b. Note aortic valve calcification (large arrows), aortic valve leaflets (small arrows), free edges of the aortic valve leaflets (black arrowheads on b), and aortic valve annulus (white arrowheads on b).

View larger version (39K): [in a new window]   Figure 6. Bland-Altman plot for measurements of aortic valve annulus diameter obtained with nonenhanced retrospectively ECG-gated multi-detector row CT compared with surgery. Differences are plotted against the mean of the two diameter measurements. Thick solid line represents the mean difference (3.0 mm), thin solid lines represent limits of agreement (range, 0-6.0 mm), and dotted line represents 0. When compared with surgery, nonenhanced imaging allowed overestimation of the diameter by an average of 3.0 mm.

View larger version (41K): [in a new window]   Figure 7. Bland-Altman plot for measurements of aortic valve annulus diameter obtained with contrast-enhanced retrospectively ECG-gated multi-detector row CT compared with surgery. Differences are plotted against the mean of the two diameter measurements. Thick solid line represents the mean difference (0.7 mm), thin solid lines represent limits of agreement (range, -1.5 mm to 2.9 mm), and dotted line represents 0. When compared with surgery, contrast-enhanced imaging allowed overestimation of the diameter by an average of 0.7 mm.