Clinical radiology · 2026
Computed tomography can assess aortic valve stenosis by planimetry, enhances the continuity equation, reveals an anatomical ratio that mimics the dimensionless velocity index and demonstrates limitations in the use of calcification in stenosis severity assessment.
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Hamilton M C K, Neumann S, Foley R W J, Biglino G, Abdelgawwad I, Nelson M, Dorman S, Joshi N, Manghat N E, Turner M S
Аннотация
AIM: Transthoracic echocardiography (TTE) grades aortic valve stenosis (AS) severity. However, this is often discordant when velocity and aortic valve area (AVA) grade boundaries are considered. We evaluated computed tomography (CT) and TTE datasets to validate CT measures of AS.
MATERIALS AND METHODS: A total of 168 sequential patients with symptomatic probable severe AS were included. CT and TTE measures of AS were made. The AVA was assessed by (1) the continuity equation, which measures the effective valve area (EOA) and (2) CT planimetry, which measures the anatomical valve area (CTP-AVA). The EOA as measured by TTE (TTE-EOA) or CT (CT-EOA) varied by whether the TTE or CT-derived left ventricular outlet area (LVOT) was used in the calculation with the TTE Doppler. Area relationships and CT aortic valve calcification (CT-AVC) data were also assessed.
RESULTS: After exclusions, 157 datasets were analysed. 119 (75.8%) had tricuspid (TAV) and 38 (24.2%) had bicuspid (BAV) aortic valve. Mean CT-EOA (1.13 ± 0.42 cm2) and CTP-AVA (1.13 ± 0.37 cm2) were near identical and correlated (R2 0.359, P<0.001). The TTE-EOA (0.82 ± 0.31 cm2) was smaller as the TTE-LVOT area (3.66 ± 0.87 cm2) was smaller than CT (5.04 ± 1.23 cm2), P<0.001. Dimensionless velocity index (0.22 ± 0.07) matched an anatomical valve index (AVI) (planimetered valve area/LVOT area) (0.23 ± 0.08), R2 = 0.378, P<0.001. CT-AVC was unhelpful in confirming severe AS with weak correlations.
CONCLUSION: We confirm the utility of CTP-AVA to assess aortic stenosis severity, quantify and highlight the variability of TTE-EOA, describe an AVI (explaining the DVI), and show that CT-AVC is inaccurate in assessing AS severity in individuals.
MATERIALS AND METHODS: A total of 168 sequential patients with symptomatic probable severe AS were included. CT and TTE measures of AS were made. The AVA was assessed by (1) the continuity equation, which measures the effective valve area (EOA) and (2) CT planimetry, which measures the anatomical valve area (CTP-AVA). The EOA as measured by TTE (TTE-EOA) or CT (CT-EOA) varied by whether the TTE or CT-derived left ventricular outlet area (LVOT) was used in the calculation with the TTE Doppler. Area relationships and CT aortic valve calcification (CT-AVC) data were also assessed.
RESULTS: After exclusions, 157 datasets were analysed. 119 (75.8%) had tricuspid (TAV) and 38 (24.2%) had bicuspid (BAV) aortic valve. Mean CT-EOA (1.13 ± 0.42 cm2) and CTP-AVA (1.13 ± 0.37 cm2) were near identical and correlated (R2 0.359, P<0.001). The TTE-EOA (0.82 ± 0.31 cm2) was smaller as the TTE-LVOT area (3.66 ± 0.87 cm2) was smaller than CT (5.04 ± 1.23 cm2), P<0.001. Dimensionless velocity index (0.22 ± 0.07) matched an anatomical valve index (AVI) (planimetered valve area/LVOT area) (0.23 ± 0.08), R2 = 0.378, P<0.001. CT-AVC was unhelpful in confirming severe AS with weak correlations.
CONCLUSION: We confirm the utility of CTP-AVA to assess aortic stenosis severity, quantify and highlight the variability of TTE-EOA, describe an AVI (explaining the DVI), and show that CT-AVC is inaccurate in assessing AS severity in individuals.