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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).

PURPOSE: To evaluate the applicability and image quality of nonenhanced and contrast material–enhanced multi–detector row computed tomography (CT) combined with retrospective electrocardiographic (ECG) gating for visualization of the aortic valve, determination of aortic valve morphology and diameter of the aortic valve annulus, and assessment of the degree of valvular calcification in patients with aortic valve stenosis, as compared with results of surgery and echocardiography.

MATERIALS AND METHODS: Prior to surgical valve replacement, 25 patients with aortic valve stenosis and sinus rhythm underwent nonenhanced (n = 15) and contrast-enhanced (n = 25) retrospectively ECG-gated multi–detector row CT. Two readers working in consensus evaluated image quality and assessed valvular morphology and the degree of valvular calcification. In addition, the diameter of the aortic valve annulus was measured. Results were compared with surgical and echocardiographic findings by using the paired sign test, statistics, and the method of Bland and Altman.

RESULTS: The aortic valve could be visualized nearly free of motion artifacts on all multi–detector row CT images. Image quality and diagnostic confidence for classification of aortic valve morphology were significantly superior on contrast-enhanced rather than nonenhanced images (P = .004 and P = .006, respectively). Nonenhanced and contrast-enhanced CT showed good agreement with surgical findings with regard to quantification of the degree of aortic valve calcification ( = 0.77 and = 0.74, respectively). Measurement of the diameter of the aortic valve annulus was more reliable on contrast-enhanced images.

CONCLUSION: Contrast-enhanced retrospectively ECG-gated multi–detector row CT allows determination of aortic valve morphology, measurement of the diameter of the aortic valve annulus, and assessment of the degree of aortic valve calcification in patients with aortic stenosis.

© RSNA, 2002

Index terms: Aortic valve, 535.12111, 535.12112, 535.12115 • Arteries, calcification, 535.817 • Computed tomography (CT), multi–detector row, 535.12111, 535.12112, 535.12115

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