HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Alkadhi, H. Articles by Boehm, T. Search for Related Content PubMed PubMed Citation Articles by Alkadhi, H. Articles by Boehm, T.

Aortic Stenosis: Comparative Evaluation of 16–Detector Row CT and Echocardiography¹

¹ From the Institute of Diagnostic Radiology (H.A., S.W., B.B., S.L., L.M.D., B.M., T.B.), Clinic for Cardiovascular Surgery (A.P.), and Institute of Anesthesia (D.B.), Division of Cardiovascular Anesthesia, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. Received March 17, 2005; revision requested May 10; revision received May 19; accepted June 20; final version accepted August 25. 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).

View larger version (123K): [in a new window]   Figure 1a: Plane selection for AVACT planimetry with multi–detector row CT in 49-year-old man with severe degenerative aortic stenosis and bicuspid valve. (a) Coronal oblique CT reformation during maximum valve opening in systole at 10% of R-R interval shows orientation of the plane (indicated by the line) selected for AVACT planimetry. (b) Image obtained with plane shown in a. (c) Image shows inner contour of the opening of the orifice manually outlined. AVACT was 0.48 cm2, which indicated critical aortic stenosis. Complete fusion of two cusps without a central raphe resulted in complete absence of a commissure to define the bicuspid valve. Note synchronization artifacts (arrows in a) in the ascending aorta and calcification-related artifacts (arrowheads in a and b) adjacent to the severely calcified cusps rated by both readers as few, grade 3.

View larger version (135K): [in a new window]   Figure 1b: Plane selection for AVACT planimetry with multi–detector row CT in 49-year-old man with severe degenerative aortic stenosis and bicuspid valve. (a) Coronal oblique CT reformation during maximum valve opening in systole at 10% of R-R interval shows orientation of the plane (indicated by the line) selected for AVACT planimetry. (b) Image obtained with plane shown in a. (c) Image shows inner contour of the opening of the orifice manually outlined. AVACT was 0.48 cm2, which indicated critical aortic stenosis. Complete fusion of two cusps without a central raphe resulted in complete absence of a commissure to define the bicuspid valve. Note synchronization artifacts (arrows in a) in the ascending aorta and calcification-related artifacts (arrowheads in a and b) adjacent to the severely calcified cusps rated by both readers as few, grade 3.

View larger version (134K): [in a new window]   Figure 1c: Plane selection for AVACT planimetry with multi–detector row CT in 49-year-old man with severe degenerative aortic stenosis and bicuspid valve. (a) Coronal oblique CT reformation during maximum valve opening in systole at 10% of R-R interval shows orientation of the plane (indicated by the line) selected for AVACT planimetry. (b) Image obtained with plane shown in a. (c) Image shows inner contour of the opening of the orifice manually outlined. AVACT was 0.48 cm2, which indicated critical aortic stenosis. Complete fusion of two cusps without a central raphe resulted in complete absence of a commissure to define the bicuspid valve. Note synchronization artifacts (arrows in a) in the ascending aorta and calcification-related artifacts (arrowheads in a and b) adjacent to the severely calcified cusps rated by both readers as few, grade 3.

View larger version (22K): [in a new window]   Figure 2a: (a) Scatterplot with linear regression fit and 95% confidence intervals for AVACT and AVATEE (AVATOE) planimetry in all 40 patients. Graph shows significant correlation between methods (r = 0.99, P < .001). (b) Bland-Altman plot of agreement between AVACT and AVATEE. Small bias of –0.08 cm2 was calculated. Dashed lines represent mean differences in squared centimeters ± 2 standard deviations (limits of agreement: –0.32, 0.16). TOE = transesophageal echocardiography.

View larger version (27K): [in a new window]   Figure 2b: (a) Scatterplot with linear regression fit and 95% confidence intervals for AVACT and AVATEE (AVATOE) planimetry in all 40 patients. Graph shows significant correlation between methods (r = 0.99, P < .001). (b) Bland-Altman plot of agreement between AVACT and AVATEE. Small bias of –0.08 cm2 was calculated. Dashed lines represent mean differences in squared centimeters ± 2 standard deviations (limits of agreement: –0.32, 0.16). TOE = transesophageal echocardiography.

View larger version (19K): [in a new window]   Figure 3a: (a) Scatterplot with linear regression fit and 95% confidence intervals for AVACT planimetry and AVATTE calculations in 20 patients with aortic stenosis shows high correlation between methods (r = 0.95, P < .001). (b) Bland-Altman plot of agreement between AVACT and AVATTE. Small bias of 0.06 cm2 was calculated. Dashed lines represent mean differences in squared centimeters ± 2 standard deviations (limits of agreement: –0.15, 0.26).

View larger version (25K): [in a new window]   Figure 3b: (a) Scatterplot with linear regression fit and 95% confidence intervals for AVACT planimetry and AVATTE calculations in 20 patients with aortic stenosis shows high correlation between methods (r = 0.95, P < .001). (b) Bland-Altman plot of agreement between AVACT and AVATTE. Small bias of 0.06 cm2 was calculated. Dashed lines represent mean differences in squared centimeters ± 2 standard deviations (limits of agreement: –0.15, 0.26).

View larger version (22K): [in a new window]   Figure 4: Scatterplot with linear regression fit and 95% confidence intervals for AVACT planimetry and mean transvalvular pressure gradients with TTE in 20 patients with aortic stenosis demonstrates significant correlation between methods (r = –0.74, P < .01).

View larger version (150K): [in a new window]   Figure 5a: Multi–detector row CT reformations and short-axis views obtained with TEE (insets) in three patients with aortic stenosis. (a) CT reformation at 10% of R-R interval and short-axis view during maximum opening in systole in 58-year-old man with one-vessel coronary artery disease show slight calcification of aortic cusps, which resulted in decreased AVA. AVACT was 1.46 cm2, which indicated mild aortic stenosis. (b) CT reformation at 5% of R-R interval in 65-year-old woman with three-vessel coronary artery disease. AVACT was 1.10 cm2, which indicated moderate aortic stenosis. (c) CT reformation at 5% of R-R interval in 73-year-old man with three-vessel coronary artery disease. AVACT was 0.93 cm2, which indicated severe aortic stenosis. Severity of cusp edge thickening and valve calcification is progressive from that on image depicting mild aortic stenosis to that depicting severe aortic stenosis. Acoustic shadow (arrows on inset in b and c) in patients with severe valve calcification compromises quality of TEE images and may hinder preciseness of planimetric measurement of AVA.

View larger version (172K): [in a new window]   Figure 5b: Multi–detector row CT reformations and short-axis views obtained with TEE (insets) in three patients with aortic stenosis. (a) CT reformation at 10% of R-R interval and short-axis view during maximum opening in systole in 58-year-old man with one-vessel coronary artery disease show slight calcification of aortic cusps, which resulted in decreased AVA. AVACT was 1.46 cm2, which indicated mild aortic stenosis. (b) CT reformation at 5% of R-R interval in 65-year-old woman with three-vessel coronary artery disease. AVACT was 1.10 cm2, which indicated moderate aortic stenosis. (c) CT reformation at 5% of R-R interval in 73-year-old man with three-vessel coronary artery disease. AVACT was 0.93 cm2, which indicated severe aortic stenosis. Severity of cusp edge thickening and valve calcification is progressive from that on image depicting mild aortic stenosis to that depicting severe aortic stenosis. Acoustic shadow (arrows on inset in b and c) in patients with severe valve calcification compromises quality of TEE images and may hinder preciseness of planimetric measurement of AVA.

View larger version (161K): [in a new window]   Figure 5c: Multi–detector row CT reformations and short-axis views obtained with TEE (insets) in three patients with aortic stenosis. (a) CT reformation at 10% of R-R interval and short-axis view during maximum opening in systole in 58-year-old man with one-vessel coronary artery disease show slight calcification of aortic cusps, which resulted in decreased AVA. AVACT was 1.46 cm2, which indicated mild aortic stenosis. (b) CT reformation at 5% of R-R interval in 65-year-old woman with three-vessel coronary artery disease. AVACT was 1.10 cm2, which indicated moderate aortic stenosis. (c) CT reformation at 5% of R-R interval in 73-year-old man with three-vessel coronary artery disease. AVACT was 0.93 cm2, which indicated severe aortic stenosis. Severity of cusp edge thickening and valve calcification is progressive from that on image depicting mild aortic stenosis to that depicting severe aortic stenosis. Acoustic shadow (arrows on inset in b and c) in patients with severe valve calcification compromises quality of TEE images and may hinder preciseness of planimetric measurement of AVA.