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Morphological assessment of the aortic valve using coronary computed tomography angiography, cardiovascular magnetic resonance, and transthoracic echocardiography: comparison with intraoperative findings

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Abstract

To compare the diagnostic accuracies of coronary computed tomography angiography (CCTA), cardiovascular magnetic resonance (CMR), and transthoracic echocardiography (TTE) in aortic valve (AV) morphological assessments with operative findings. We retrospectively enrolled 262 patients who underwent CCTA, CMR, and TTE before AV surgery. Two independent blinded observers assessed AV morphology as being tricuspid, bicuspid, or quadricuspid using three imaging modalities. Interobserver and intermodality agreements were obtained with kappa statistics. The diagnostic accuracies of CCTA, CMR, and TTE for identifying AV morphology (tricuspid vs. non-tricuspid) were compared with intraoperative findings as the reference standard. At surgery, tricuspid AV, bicuspid AV, and quadricuspid AV were present in 179, 80, and 3 patients, respectively. The CCTA and CMR image qualities were all diagnostic. Thirteen cases of TTE were not evaluable due to severe AV calcification. An excellent correlation between CMR and CCTA was seen for the identification of AV morphology (κ = 0.97). Good correlations existed between CCTA and TTE (κ = 0.72) and between CMR and TTE (κ = 0.74). CCTA, CMR, and TTE had an excellent or good interobserver agreement (κ = 0.90, 0.95, and 0.72, respectively). Sensitivity, specificity, and positive and negative predictive values for AV morphology assessment (tricuspid vs. non-tricuspid) were: 97, 95, 98, and 94 % with CCTA (n = 262); 98, 96, 98, and 95 % with CMR (n = 262); and 98, 88, 95, and 96 % with TTE (n = 249). CCTA and CMR are highly accurate for identifying AV morphology.

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Abbreviations

AR:

Aortic regurgitation

AS:

Aortic stenosis

AV:

Aortic valve

AVR:

Aortic valve replacement

BAV:

Bicuspid aortic valve

CCTA:

Coronary computed tomography angiography

CMR:

Cardiovascular magnetic resonance

DLP:

Dose-length product

ECG:

Electrocardiography

HR:

Heart rate

LV:

Left ventricular

MDCT:

Multidetector computed tomography

QAV:

Quadricuspid aortic valve

TAV:

Tricuspid aortic valve

TTE:

Transthoracic echocardiography

VHD:

Valvular heart disease

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Authors and Affiliations

  1. Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Seung Choul Lee & Sung Min Ko

  2. Research Institute of Medical Science, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Sung Min Ko

  3. Department of Thoracic Surgery, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Meong Gun Song, Je Kyoun Shin & Hyun Keun Chee

  4. Department of Cardiology, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Hweung Kon Hwang

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  1. Seung Choul Lee
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Correspondence to Sung Min Ko.

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Lee, S.C., Ko, S.M., Song, M.G. et al. Morphological assessment of the aortic valve using coronary computed tomography angiography, cardiovascular magnetic resonance, and transthoracic echocardiography: comparison with intraoperative findings. Int J Cardiovasc Imaging 28 (Suppl 1), 33–44 (2012). https://doi.org/10.1007/s10554-012-0066-9

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  • DOI: https://doi.org/10.1007/s10554-012-0066-9

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