CT and MR of the Aortic Valve

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 3.75
Procedures: 3.75
Diagnostic and Conduction System Studies: 1.75
Hemodynamics, Calculations, and Percutaneous Intervention: 2.00

Computed Tomography: 3.75
Procedures: 3.75
Neck and Chest: 3.75

Registered Radiologist Assistant: 3.75
Procedures: 3.75
Thoracic Section: 3.75

Outline

1. Introduction
2. Imaging Techniques
   1. Cardiac CT
   2. MR Imaging
   3. Quantitative Techniques
      1. Measurement of Calcification
      2. Planimetry
      3. Assessment of Ventricular Volume and Mass
      4. Two-dimensional Phse-Contrast MR Imaging
      5. Four-dimensional Phase-Contrast MR Imaging
3. Normal Anatomy of the Aortic Valve
4. Congenital Abnormalities of the Aortic Valve
5. Aortic Stenosis
6. Aortic Regurgitation
7. Vegetations and Masses
   1. Bacterial Endocarditis
   2. Papillary Fibroelastomas
8. Conclusions

Objectives

Upon completion of this course, students will:

1. know the third most prevalent form of cardiovascular disease in the United States
2. know which two heart valves are most often affected by rheumatic fever
3. name the substance deposited in valve leaflets that results in degenerative valvular heart disease
4. know which patient conditions may limit evaluation of the aortic valve by transthoracic echocardiography
5. be familiar with the range of pixel sizes in CT imaging of the aortic valve
6. know the tube voltage commonly used for CT of the aortic valve
7. define pitch
8. understand how beta-blockers may be used in CT of the heart and aortic valve
9. be able to name a CT examination of the aorta or aortic valve that does not use contrast media
10. know the 5 standardized ultrasound transducer positions for heart and valve evaluation
11. understand the advantages and disadvantages of parallel imaging in MR
12. be familiar with an en face view of the aortic valve
13. know what a flow jet looks like on cine-MR images
14. understand how delayed contrast-enhanced MR images can provide prognostic information in the setting of aortic stenosis
15. know how valvular calcification is expressed
16. know if MR can be used to quantify valvular calcification
17. be familiar with planimetry and the images used to obtain the measurement
18. know what principle the continuity equation is based on
19. understand which parameters are associated with a poor outcome in asymptomatic patients with aortic stenosis
20. know how to calculate ejection fraction
21. know when papillary muscles and endocardial trabeculae are included in calculation of ventricular mass
22. understand the relationship between left and right ventricular stroke volumes
23. be familiar with calculation of blood flow velocity
24. know the phase shift associated with maximum velocity at a given VENC
25. be able to recognize aliasing in velocity encoded images
26. know what mean pressure gradient classifies aortic stenosis as severe
27. understand which congenital conditions may be diagnosed with the Qp/Qs ratio
28. know where measurements are commonly made for evaluation of the aortic root
29. identify the nodule on the closing edge of the aortic valve cusps
30. know the approximate number of cardiac cycles per year
31. know which heart valve is completely supported by a muscular outflow tract
32. know the amount of backpressure in the aorta during diastole
33. be familiar with recommended intervention timing for an asymptomatic aortic aneurysm in patients with a bicuspid aortic valve versus the general population
34. know which cusps are most commonly fused in bicuspid aortic valves
35. list possible causes of acquired sinus of Valsalva aneurysms
36. know what substance is responsible for ventricular dysfunction in cases of myocardial fibrosis
37. state the average survival time of symptomatic patients with aortic stenosis who do not have valve replacement
38. be familiar with a common term for severe aortic calcification
39. list treatment options for a stenotic aortic valve
40. know causes of aortic valve regurgitation that impair valve leaflet function
41. describe factors that may limit sensitivity of CT to demonstrate the regurgitant orifice
42. know some conditions that may increase incidence of bacterial endocarditis
43. understand why valvular bacterial endocarditis may be difficult to treat
44. know the size of valvular vegetative lesion that can be reliably identified with CT
45. know the decades of peak occurrence of papillary fibroelastoma