Cardiac Valve Assessment with MR Imaging and 64-Section Multi–Detector Row CT

Movies 1, 2. Mitral valve anatomy at (1) multi–detector row CT versus (2) 1.5-T MR imaging. Four-dimensional 64-section multi–detector row cine CT shows better image resolution than 1.5-T SSFP cine MR imaging, but the cine MR shows better temporal resolution. The images were obtained in two different patients.

Movies , 4, 5. Cine loops of normal valves at SSFP MR imaging. SSFP MR imaging shows the tricuspid valve with the anterior papillary muscle originating from the moderator band, a normal mitral valve, and a normal aortic valve. Movie 4 shows a vertical long-axis two-chamber view.

Movie 6. Aortic regurgitation in a 58-year-old woman. Cine MR imaging shows a signal void (jet) in the left ventricular outflow tract due to turbulent flow. 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.

Movie 7. Aortic stenosis in a 62-year-old man. SSFP cine MR imaging shows a signal void (jet) in the ascending aorta due to turbulent flow in the aortic root.

Movie 8. Idiopathic hypertrophic obstructive cardiomyopathy in a 25-year-old woman with moderate subaortic stenosis. SSFP cine MR imaging shows a signal void (jet) in the left ventricular outflow tract due to turbulent flow. 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.

Movies 9, 10. (9) Magnitude phase-contrast cine MR imaging used for anatomic correlation. (10) At velocity cine MR imaging, the gray-scale value of each voxel represents the velocity value of that voxel. Black areas represent caudal blood flow in the descending aorta, and white areas represent cephalad flow in the ascending aorta. The thoracic wall demonstrates an intermediate signal intensity that corresponds to no flow.

Movies 11, 12, 13, 14. MIP reformatted cines from 64-section multi–detector row CT data show a normal aortic valve in closed position. Inverted gray-scale (reverse ramp) 4D multi–detector row cine CT (12, 14) is often useful for depicting valve motion more clearly.

Movies 15, 16, 17, 18, 19, 20. (15–19) MIP reformatted cines from multi–detector row CT data demonstrate a normal mitral valve and a pulmonary valve that is located anterior, superior, and to the left of the aortic valve. Because saline chaser is administered to our coronary CT angiography patients, there is reduced contrast in the right ventricle. (16, 18) Reverse ramp multi–detector row cine CT. (20) MIP reformatted cine from multi–detector row CT data demonstrates the tricuspid valve), which is difficult to evaluate owing to the reduced contrast (cf 19).

Movie 21. Bicuspid aortic valve in a 61-year-old man. MIP reformatted cine from 64-section multi–detector row CT data show the aortic valve in systole. 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.

Movies 22, 23. Valve prosthesis in a 55-year-old patient with a history of transmural myocardial infarction and left ventricular reconstruction surgery (Dor procedure). Horizontal (22) and vertical (23) long-axis SSFP cine MR imaging demonstrates a functional mitral valve with no evidence of a jet in the left atrium, findings that suggest mitral regurgitation. A prosthetic ring (23) was inserted at the mitral annulus for treatment of regurgitation.

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