Document Detail

Grading of aortic valve stenosis at 64-slice spiral computed tomography: comparison with transthoracic echocardiography and calibration against cardiac catheterization.
MedLine Citation:
PMID:  19412115     Owner:  NLM     Status:  MEDLINE    
PURPOSE: We sought to determine the accuracy of multislice spiral computed tomography (MSCT) for assessing of aortic valve stenosis and to establish threshold values of the planimetric aortic valve orifice area (AVA) that best separate between different grades of stenosis severity. MATERIALS AND METHODS: A total of 202 patients (among them 160 patients with aortic valve stenosis) underwent MSCT, transthoracic echocardiography (TTE) and cardiac catheterization (CATH). Planimetric AVA measurements at MSCT were compared with calculations based on Doppler flow velocity measurements by TTE (using the continuity equation) and pressure gradient measurements by CATH (using the Gorlin formula). RESULTS: Series of AVA measurements correlated well between MSCT and TTE (r = 0.86) and between MSCT and CATH (r = 0.90). However, AVA at MSCT (0.98 +/- 0.47 cm) was significantly larger than AVA at TTE (0.81 +/- 0.36 cm; P < 0.05) and CATH (0.80 +/- 0.39 cm; P < 0.05). For severity grades 0 through IV the AVAs at MSCT were 2.69 +/- 0.75, 1.86 +/- 0.30, 1.48 +/- 0.17, 0.95 +/- 0.20, and 0.68 +/- 0.20 cm, respectively. For separating, the 5 severity grades optimal thresholds at MSCT were 2.1, 1.6, 1.2, and 0.9 cm. Using these adjusted thresholds there was perfect agreement in classification between MSCT and CATH in 156 (77%), but a mismatch by 1 grade in 43 (21.5%) and 2 grades in 3 (1.5%) patients (kappaw = 0.86). CONCLUSION: Planimetric AVA measurements on MSCT allows for an accurate grading of aortic valve stenosis severity. However, AVA measurements on MSCT are usually larger than measurements on TTE and CATH. Consequently, the thresholds for discriminating between different severity grades have to be adjusted in MSCT.
Alexander Lembcke; Michael Woinke; Adrian C Borges; Pascal M Dohmen; André Lachnitt; Yvonne Westermann; Anja Geigenmueller; Kay G A Hermann; Craig Butler; Holger Thiele; Dietmar E Kivelitz
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Investigative radiology     Volume:  44     ISSN:  1536-0210     ISO Abbreviation:  Invest Radiol     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-20     Completed Date:  2009-08-05     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0045377     Medline TA:  Invest Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  360-8     Citation Subset:  IM    
Department of Radiology, Charité, University Medicine Berlin, Berlin, Germany.
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MeSH Terms
Aortic Valve Stenosis / classification,  radiography*,  ultrasonography*
Aortography / methods*,  standards
Echocardiography / methods*,  standards
Heart Catheterization / methods*,  standards
Radiographic Image Interpretation, Computer-Assisted / methods*
Reproducibility of Results
Sensitivity and Specificity
Tomography, X-Ray Computed / methods*,  standards

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