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CT in evaluation of MS patients

Author: Tarun Mittal


 

Like 3DE, CT cardiac angiogram (CTCA) is a volumetric technique (0.3-0.5mm isotropic resolution) and thus allows precise alignment to the plane of mitral annulus or the valve. The scan has to be acquired to cover the required diastolic phase of the cardiac cycle (prospective ECG gating with a wide padding in diastolic phase or retrospective gating with ECG modulation).

Alignment of mitral annulus plane in two orthogonal planes on CCTA with planimetry of the annulus

 

CCTA images demonstrating alignment to the mitral valve orifice using the two orthogonal planes. This is a normal valve in late diastolic phase.

 

CCTA is very sensitive in detecting calcification anywhere in the body, and hence shows it very well in the mitral annulus and valve.
CCTA short-axis image demonstrating calcification (bright density) along the inferior and posterior aspects of mitral annulus with extension into the adjacent valve

 

http://www.youtube.com/watch?v=meq_OmMRcIc
Cine CCTA in apical 4c view demonstrating restricted MV due to severe calcification in the annulus CCTA (same patient) in short axis plane view demonstrating valve area measured in mid-diastolic phase

 

http://www.youtube.com/watch?v=_CcHM1NhrVI
http://www.youtube.com/watch?v=l_9T2D1WGdo
Long axis CCTA cine of a patient with rheumatic mitral valve disease Short axis CCTA (cine) images of a patient with rheumatic mitral valve disease