DOI: 10.1148/rg.266065035
Cardiac Valve Assessment with MR Imaging and 64-Section Multi–Detector Row CT1
Jens Vogel-Claussen, MD,
Harpreet Pannu, MD,
Philip J. Spevak, MD,
Elliot K. Fishman, MD and
David A. Bluemke, MD, PhD
1 From the Russell H. Morgan Department of Radiology and Radiological Science (J.V.C., H.P., E.K.F., D.A.B.) and the Departments of Pediatrics and Medicine (P.J.S.), The Johns Hopkins Hospital, MRI, Room 143 (Nelson Basement), 600 N Wolfe St, Baltimore, MD 21287. Recipient of a Cum Laude award for an education exhibit at the 2005 RSNA Annual Meeting. Received March 21, 2006; revision requested April 17 and received August 4; accepted August 11. J.V.C. was supported by the Radiological Society of North America Research and Education Foundation; P.J.S. is a stockholder of General Electric; E.K.F. was supported by Siemens AG and General Electric, is a member of the advisory boards for Siemens AG and General Electric, and is a cofounder of Hip Graphics; D.A.B. was supported by EPIX Pharmaceuticals and is a consultant for the Bracco Group and Schering AG (Berlex). H.P. has no financial relationships to disclose.
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Figure 1a. Mitral valve anatomy at 64-section multi–detector row CT versus 1.5-T MR imaging. Four-dimensional 64-section multi–detector row CT scan (a) shows better image resolution than a 1.5-T SSFP MR image (b), but the MR image shows better temporal resolution. Arrow indicates the posterior leaflet of the mitral valve, which is more clearly defined on the CT scan. The two images were obtained in two different patients.
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Figure 1b. Mitral valve anatomy at 64-section multi–detector row CT versus 1.5-T MR imaging. Four-dimensional 64-section multi–detector row CT scan (a) shows better image resolution than a 1.5-T SSFP MR image (b), but the MR image shows better temporal resolution. Arrow indicates the posterior leaflet of the mitral valve, which is more clearly defined on the CT scan. The two images were obtained in two different patients.
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Figure 2. Diagram illustrates the double inversion recovery black blood MR imaging technique. Blood flowing into the image plane appears black; however, in-plane–flowing blood or slow-flowing blood may not be entirely suppressed with this technique. FSE = fast spin echo, TI = inversion time.
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Figure 3. Tetralogy of Fallot in a 6-month-old patient with cyanosis. Black blood MR image of the heart demonstrates the key features of tetralogy of Fallot, a congenital cardiac malformation: a large, malalignment-type ventricular septal defect (VSD); an overriding aorta (AO); and right ventricular hypertrophy (RVH) due to pulmonic stenosis.
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Figure 4a. Cine loops of normal valves at SSFP MR imaging. SSFP MR images show the tricuspid valve (arrow in a) with the anterior papillary muscle originating from the moderator band (arrowhead in a), a normal mitral valve (arrow in b), and a normal aortic valve (arrowhead in c). The image in b is a vertical long-axis two-chamber view.
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Figure 4b. Cine loops of normal valves at SSFP MR imaging. SSFP MR images show the tricuspid valve (arrow in a) with the anterior papillary muscle originating from the moderator band (arrowhead in a), a normal mitral valve (arrow in b), and a normal aortic valve (arrowhead in c). The image in b is a vertical long-axis two-chamber view.
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Figure 4c. Cine loops of normal valves at SSFP MR imaging. SSFP MR images show the tricuspid valve (arrow in a) with the anterior papillary muscle originating from the moderator band (arrowhead in a), a normal mitral valve (arrow in b), and a normal aortic valve (arrowhead in c). The image in b is a vertical long-axis two-chamber view.
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Figure 5. Segmented k-space acquisition technique in SSFP cine MR imaging. Images A–C demonstrate segmented k-space acquisition in systolic and diastolic segments with an echo train length of 10. D shows Fourier transform SSFP cine images in systole and diastole. The shorter the echo train length within a segment, the longer the image acquisition time and the higher the temporal resolution of the SSFP cine MR images.
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Figure 6. Aortic regurgitation in a 58-year-old woman. Cine MR image shows a signal void (jet) in the left ventricular outflow tract due to turbulent flow. Arrow indicates aortic regurgitation. There was also anterior motion (flutter) of the anterior mitral valve leaflet during diastole due to the turbulent regurgitant flow in the left ventricular outflow tract.
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Figure 8. Idiopathic hypertrophic obstructive cardiomyopathy in a 25-year-old woman with moderate subaortic stenosis. SSFP cine MR image shows a signal void (jet) in the left ventricular outflow tract due to turbulent flow (arrow). Systolic anterior motion of the anterior leaflet of the mitral valve caused by negative pressure in the left ventricular outflow tract was also present. The systolic anterior motion of the mitral valve led to mitral regurgitation, which caused moderate to severe dilatation of the left atrium (arrowhead).
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Figure 9a. (a) Magnitude phase-contrast MR image used for anatomic correlation. (b) On a velocity MR image, the gray-scale value of each voxel represents the velocity value of that voxel. Black areas represent caudal blood flow in the descending aorta (arrowhead), white areas represent cephalad flow in the ascending aorta (arrow). The thoracic wall demonstrates an intermediate signal intensity that corresponds to no flow.
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Figure 9b. (a) Magnitude phase-contrast MR image used for anatomic correlation. (b) On a velocity MR image, the gray-scale value of each voxel represents the velocity value of that voxel. Black areas represent caudal blood flow in the descending aorta (arrowhead), white areas represent cephalad flow in the ascending aorta (arrow). The thoracic wall demonstrates an intermediate signal intensity that corresponds to no flow.
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Figure 10a. Normal aortic valve. (a) On a velocity phase-contrast MR image, orthogonal measurements of the ascending aorta at the level of the pulmonary bifurcation (outlined in red) have been performed. (b) Flow volume graph of one cardiac cycle illustrates a normal flow curve.
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Figure 10b. Normal aortic valve. (a) On a velocity phase-contrast MR image, orthogonal measurements of the ascending aorta at the level of the pulmonary bifurcation (outlined in red) have been performed. (b) Flow volume graph of one cardiac cycle illustrates a normal flow curve.
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Figure 11a. (a, b) Velocity (a) and magnitude (b) phase-contrast MR images obtained in a patient with tetralogy of Fallot repair, pulmonary artery outflow tract reconstruction, and absence of the pulmonary valve show the main pulmonary artery (outlined in red). (c) Flow volume graph of one cardiac cycle illustrates a 26% regurgitant fraction of the pulmonary artery outflow tract.
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Figure 11b. (a, b) Velocity (a) and magnitude (b) phase-contrast MR images obtained in a patient with tetralogy of Fallot repair, pulmonary artery outflow tract reconstruction, and absence of the pulmonary valve show the main pulmonary artery (outlined in red). (c) Flow volume graph of one cardiac cycle illustrates a 26% regurgitant fraction of the pulmonary artery outflow tract.
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Figure 11c. (a, b) Velocity (a) and magnitude (b) phase-contrast MR images obtained in a patient with tetralogy of Fallot repair, pulmonary artery outflow tract reconstruction, and absence of the pulmonary valve show the main pulmonary artery (outlined in red). (c) Flow volume graph of one cardiac cycle illustrates a 26% regurgitant fraction of the pulmonary artery outflow tract.
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Figure 12a. MIP reformatted images from 64-section multi–detector row CT data show a normal aortic valve (arrow) in closed (a–c, e) and open (d, f) position. Inverted gray-scale (reverse ramp) 4D multi–detector row CT images (b, e, f) are often useful for depicting valve motion more clearly.
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Figure 12b. MIP reformatted images from 64-section multi–detector row CT data show a normal aortic valve (arrow) in closed (a–c, e) and open (d, f) position. Inverted gray-scale (reverse ramp) 4D multi–detector row CT images (b, e, f) are often useful for depicting valve motion more clearly.
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Figure 12c. MIP reformatted images from 64-section multi–detector row CT data show a normal aortic valve (arrow) in closed (a–c, e) and open (d, f) position. Inverted gray-scale (reverse ramp) 4D multi–detector row CT images (b, e, f) are often useful for depicting valve motion more clearly.
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Figure 12d. MIP reformatted images from 64-section multi–detector row CT data show a normal aortic valve (arrow) in closed (a–c, e) and open (d, f) position. Inverted gray-scale (reverse ramp) 4D multi–detector row CT images (b, e, f) are often useful for depicting valve motion more clearly.
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Figure 12e. MIP reformatted images from 64-section multi–detector row CT data show a normal aortic valve (arrow) in closed (a–c, e) and open (d, f) position. Inverted gray-scale (reverse ramp) 4D multi–detector row CT images (b, e, f) are often useful for depicting valve motion more clearly.
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Figure 12f. MIP reformatted images from 64-section multi–detector row CT data show a normal aortic valve (arrow) in closed (a–c, e) and open (d, f) position. Inverted gray-scale (reverse ramp) 4D multi–detector row CT images (b, e, f) are often useful for depicting valve motion more clearly.
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Figure 13a. (a–e) MIP reformatted images from multi–detector row CT data demonstrate a normal mitral valve (arrow in a and b) and a pulmonary valve that is located anterior, superior, and to the left of the aortic valve (arrow in c–e). Because saline chaser is administered to our coronary CT angiography patients, there is reduced contrast in the right ventricle (arrowhead in e). Reverse ramp multi–detector row CT images are shown in b and d. (f) MIP reformatted image from multi–detector row CT data demonstrates the tricuspid valve (arrow), which is difficult to evaluate owing to the reduced contrast (cf e).
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Figure 13b. (a–e) MIP reformatted images from multi–detector row CT data demonstrate a normal mitral valve (arrow in a and b) and a pulmonary valve that is located anterior, superior, and to the left of the aortic valve (arrow in c–e). Because saline chaser is administered to our coronary CT angiography patients, there is reduced contrast in the right ventricle (arrowhead in e). Reverse ramp multi–detector row CT images are shown in b and d. (f) MIP reformatted image from multi–detector row CT data demonstrates the tricuspid valve (arrow), which is difficult to evaluate owing to the reduced contrast (cf e).
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Figure 13c. (a–e) MIP reformatted images from multi–detector row CT data demonstrate a normal mitral valve (arrow in a and b) and a pulmonary valve that is located anterior, superior, and to the left of the aortic valve (arrow in c–e). Because saline chaser is administered to our coronary CT angiography patients, there is reduced contrast in the right ventricle (arrowhead in e). Reverse ramp multi–detector row CT images are shown in b and d. (f) MIP reformatted image from multi–detector row CT data demonstrates the tricuspid valve (arrow), which is difficult to evaluate owing to the reduced contrast (cf e).
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Figure 13d. (a–e) MIP reformatted images from multi–detector row CT data demonstrate a normal mitral valve (arrow in a and b) and a pulmonary valve that is located anterior, superior, and to the left of the aortic valve (arrow in c–e). Because saline chaser is administered to our coronary CT angiography patients, there is reduced contrast in the right ventricle (arrowhead in e). Reverse ramp multi–detector row CT images are shown in b and d. (f) MIP reformatted image from multi–detector row CT data demonstrates the tricuspid valve (arrow), which is difficult to evaluate owing to the reduced contrast (cf e).
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Figure 13e. (a–e) MIP reformatted images from multi–detector row CT data demonstrate a normal mitral valve (arrow in a and b) and a pulmonary valve that is located anterior, superior, and to the left of the aortic valve (arrow in c–e). Because saline chaser is administered to our coronary CT angiography patients, there is reduced contrast in the right ventricle (arrowhead in e). Reverse ramp multi–detector row CT images are shown in b and d. (f) MIP reformatted image from multi–detector row CT data demonstrates the tricuspid valve (arrow), which is difficult to evaluate owing to the reduced contrast (cf e).
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Figure 13f. (a–e) MIP reformatted images from multi–detector row CT data demonstrate a normal mitral valve (arrow in a and b) and a pulmonary valve that is located anterior, superior, and to the left of the aortic valve (arrow in c–e). Because saline chaser is administered to our coronary CT angiography patients, there is reduced contrast in the right ventricle (arrowhead in e). Reverse ramp multi–detector row CT images are shown in b and d. (f) MIP reformatted image from multi–detector row CT data demonstrates the tricuspid valve (arrow), which is difficult to evaluate owing to the reduced contrast (cf e).
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Figure 14a. Bicuspid aortic valve in a 61-year-old man. (a, b) Endoluminal VR reformatted images from 64-section multi–detector row CT data show a bicuspid aortic valve in open (a) and closed (b) position. (c, d) MIP reformatted images from 64-section multi–detector row CT data show the aortic valve (arrow) in systole (c) and diastole (d). Bicuspid valves occur in 2% of the population (29), and one-half of affected patients develop at least mild aortic stenosis by the age of 50 years. However, the patient in this case had no significant stenosis or aortic valve calcifications.
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Figure 14b. Bicuspid aortic valve in a 61-year-old man. (a, b) Endoluminal VR reformatted images from 64-section multi–detector row CT data show a bicuspid aortic valve in open (a) and closed (b) position. (c, d) MIP reformatted images from 64-section multi–detector row CT data show the aortic valve (arrow) in systole (c) and diastole (d). Bicuspid valves occur in 2% of the population (29), and one-half of affected patients develop at least mild aortic stenosis by the age of 50 years. However, the patient in this case had no significant stenosis or aortic valve calcifications.
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Figure 14c. Bicuspid aortic valve in a 61-year-old man. (a, b) Endoluminal VR reformatted images from 64-section multi–detector row CT data show a bicuspid aortic valve in open (a) and closed (b) position. (c, d) MIP reformatted images from 64-section multi–detector row CT data show the aortic valve (arrow) in systole (c) and diastole (d). Bicuspid valves occur in 2% of the population (29), and one-half of affected patients develop at least mild aortic stenosis by the age of 50 years. However, the patient in this case had no significant stenosis or aortic valve calcifications.
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Figure 14d. Bicuspid aortic valve in a 61-year-old man. (a, b) Endoluminal VR reformatted images from 64-section multi–detector row CT data show a bicuspid aortic valve in open (a) and closed (b) position. (c, d) MIP reformatted images from 64-section multi–detector row CT data show the aortic valve (arrow) in systole (c) and diastole (d). Bicuspid valves occur in 2% of the population (29), and one-half of affected patients develop at least mild aortic stenosis by the age of 50 years. However, the patient in this case had no significant stenosis or aortic valve calcifications.
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Figure 16a. Aortic valve calcifications. Sixty-four–section multi–detector row CT scans show minimal aortic valve calcifications without significant aortic stenosis (arrow in a), moderate aortic valve calcifications (arrow in b), and severe aortic valve calcifications causing significant aortic stenosis (arrow in c and d). Note also the concentric left ventricular hypertrophy (arrowhead in d).
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Figure 16b. Aortic valve calcifications. Sixty-four–section multi–detector row CT scans show minimal aortic valve calcifications without significant aortic stenosis (arrow in a), moderate aortic valve calcifications (arrow in b), and severe aortic valve calcifications causing significant aortic stenosis (arrow in c and d). Note also the concentric left ventricular hypertrophy (arrowhead in d).
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Figure 16c. Aortic valve calcifications. Sixty-four–section multi–detector row CT scans show minimal aortic valve calcifications without significant aortic stenosis (arrow in a), moderate aortic valve calcifications (arrow in b), and severe aortic valve calcifications causing significant aortic stenosis (arrow in c and d). Note also the concentric left ventricular hypertrophy (arrowhead in d).
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Figure 16d. Aortic valve calcifications. Sixty-four–section multi–detector row CT scans show minimal aortic valve calcifications without significant aortic stenosis (arrow in a), moderate aortic valve calcifications (arrow in b), and severe aortic valve calcifications causing significant aortic stenosis (arrow in c and d). Note also the concentric left ventricular hypertrophy (arrowhead in d).
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Figure 17a. Aortic valve replacement. (a–c) Sixty-four–section multi–detector row CT scans show a mechanical bileaflet valve (arrow) during diastole (a) and systole (b, c). (d, e) Sixty-four–section multi–detector row CT scans obtained in a different patient with an aortic valve bioprosthesis (arrow) reveal how metallic streak artifacts can make evaluation of the leaflet challenging.
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Figure 17b. Aortic valve replacement. (a–c) Sixty-four–section multi–detector row CT scans show a mechanical bileaflet valve (arrow) during diastole (a) and systole (b, c). (d, e) Sixty-four–section multi–detector row CT scans obtained in a different patient with an aortic valve bioprosthesis (arrow) reveal how metallic streak artifacts can make evaluation of the leaflet challenging.
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Figure 17c. Aortic valve replacement. (a–c) Sixty-four–section multi–detector row CT scans show a mechanical bileaflet valve (arrow) during diastole (a) and systole (b, c). (d, e) Sixty-four–section multi–detector row CT scans obtained in a different patient with an aortic valve bioprosthesis (arrow) reveal how metallic streak artifacts can make evaluation of the leaflet challenging.
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Figure 17d. Aortic valve replacement. (a–c) Sixty-four–section multi–detector row CT scans show a mechanical bileaflet valve (arrow) during diastole (a) and systole (b, c). (d, e) Sixty-four–section multi–detector row CT scans obtained in a different patient with an aortic valve bioprosthesis (arrow) reveal how metallic streak artifacts can make evaluation of the leaflet challenging.
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Figure 17e. Aortic valve replacement. (a–c) Sixty-four–section multi–detector row CT scans show a mechanical bileaflet valve (arrow) during diastole (a) and systole (b, c). (d, e) Sixty-four–section multi–detector row CT scans obtained in a different patient with an aortic valve bioprosthesis (arrow) reveal how metallic streak artifacts can make evaluation of the leaflet challenging.
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Figure 18a. Valve prosthesis in a 55-year-old patient with a history of transmural myocardial infarction and left ventricular reconstruction surgery (Dor procedure). Horizontal (a) and vertical (b) long-axis SSFP cine MR images demonstrate a functional mitral valve (arrow) with no evidence of a jet in the left atrium, findings that suggest mitral regurgitation. A prosthetic ring (arrowhead in b) was inserted at the mitral annulus for treatment of regurgitation.
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Figure 18b. Valve prosthesis in a 55-year-old patient with a history of transmural myocardial infarction and left ventricular reconstruction surgery (Dor procedure). Horizontal (a) and vertical (b) long-axis SSFP cine MR images demonstrate a functional mitral valve (arrow) with no evidence of a jet in the left atrium, findings that suggest mitral regurgitation. A prosthetic ring (arrowhead in b) was inserted at the mitral annulus for treatment of regurgitation.
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Copyright © 2006 by the Radiological Society of North America.
