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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).

Purpose: To prospectively evaluate whether planimetric measurements of aortic valve area (AVA) with 16–detector row computed tomography (CT) allow classification of aortic stenosis (AS).

Materials and Methods: The study had institutional review board approval; patients gave informed consent. Twenty patients (11 men, nine women; mean age, 63 years) with AS and 20 patients (10 men, 10 women; mean age, 65 years) without underwent transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and retrospectively electrocardiographically gated 16–detector row CT. Twenty CT data sets were reconstructed in 5% steps of R-R interval; data analysis was performed with four-dimensional software. Maximum AVA in systole planimetrically measured with CT (AVA_CT) was compared with AVA planimetrically measured with TEE (AVA_TEE), AVA calculated with the continuity equation and TTE (AVA_TTE), and transvalvular pressure gradients determined with the Bernoulli equation and TTE. Correlations among AVA_CT, AVA_TTE, AVA_TEE, and transvalvular pressure gradients were tested with bivariate regression analysis; agreement between methods was assessed with the Bland-Altman method.

Results: In patients without AS, mean AVA_CT was 3.56 cm² ± 0.66 and mean AVA_TEE was 3.43 cm² ± 0.69. In patients with AS, mean AVA_CT was 0.89 cm² ± 0.35; mean AVA_TEE, 0.86 cm² ± 0.35; and mean AVA_TTE, 0.83 cm² ± 0.33. Mean transvalvular pressure gradient was 51 mm Hg ± 22. Significant correlations were present between AVA_CT and AVA_TEE (r = 0.99, P < .001), AVA_CT and AVA_TTE (r = 0.95, P < .001), and AVA_CT and transvalvular pressure gradients (r = –0.74, P < .01). Mean differences were –0.08 cm² (limits of agreement: –0.32, 0.16) for AVA_CT versus AVA_TEE and 0.06 cm² (limits of agreement: –0.15, 0.26) for AVA_CT versus AVA_TTE.

Conclusion: Planimetric measurements of AVA with retrospectively electrocardiographically gated 16–detector row CT allow classification of AS that is similar to that achieved with measurements by using echocardiographic methods.

© RSNA, 2006

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