Valvular Imaging Optimizing Data Acquisition and Interpretation

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1 Valvular Imaging Optimizing Data Acquisition and Interpretation Suhny Abbara, MD Director Cardiovascular Imaging Section, Massachusetts General Hospital Assistant Professor, Harvard Medical School

2 Disclosures Medical Advisory Board Member Partners Imaging Perceptive Informatics Magellan Healthcare Consultant / Editing / Authoring (honoraria): EZEM Siemens Medical Systems Amirsys, Inc. Member, Board of Directors Certification Board of Cardiovascular CT (CBCCT)

3 Role of cardiac CT

4 Aortic Valve

5 Stenotic Aortic Valve LAA RVOT LA RA

6 ma modulation according to EKG max. ma 0 ma

7 ma modulation according to EKG max. ma 0 ma

8 Aortic Valve with Tube Modulation

9 How to Reconstruct Raw Data? Abbara et al. AJR 2007; 188(2):

10 Phase Definition is Vendor Dependent HR=60; R R = 1000ms 50% reconstruction Phase start = 500ms Phase start = 500ms ½ temporal window [~415ms]

11 Phase Definition is Vendor Dependent HR=60; R R = 1000ms 50% reconstruction Phase start = 500ms Rule of Thumb: Siemens x% equivalent to GE,Philips,Toshiba x+10% e.g. Siemens 35% to GE 45% Phase start = 500ms ½ temporal window [~415ms] Relationship is dependent on HR, reconstruction algorithm (single vs. multi segment) and gantry rotation speed.

12 How to Reconstruct Raw Data? Hr = 60bpm 0ms Systole 500ms Diastole 1000ms Hr = 100bpm 0ms Systole Diastole 600ms Abbara et al. AJR 2007; 188(2):

13 What Phase to choose for Planimetry? Abbara et al. Am J Roentgenol Feb;188(2):

14 Phase Start (ms after R peak) Abbara et al. 6 th International Conference on Cardiac CT, 2005

15 % of cases Phase Start in ms Abbara et al. 6 th International Conference on Cardiac CT, 2005

16 Incidence of Artifacts in the Aortic Valve 90% 80% 70% 60% 50% 40% 38% 76% 43% 73% 30% 20% 10% 13% 25% 5% 20% 7% 26% 0% 0ms 50ms 100ms 150ms 200ms double contour incomplete contour Abbara et al. Am J Roentgenol Feb;188(2): Reconstruction Phase Start

17 What Phase to choose for Planimetry? Abbara et al. Am J Roentgenol Feb;188(2):

18 Aortic Regurgitation Stenosis A Soni, S Abbara. CT Assessment of Vavlular Heart Disease. In: E Braunwald et al. Harrison s Online. 2008

19 Aortic Valve Function Aortic Regurgitation Stenosis

20 Aortic stenosis: comparison of 16 MDCT and TEE r = 0.99 p <.001 CT CT for quantification of Stenosis & Regurgitation Covered in Following Presentation by Dr. Hatem Alkadhi Radiology Jul;240(1): H. Alkadhi et al. TEE

21 MIP MinIP

22 Bouvier et al., European Heart Journal 2006

23 Congenital Bicuspid Aortic Valve RR Colen, JD Dodd, JB Roedl, RC Cury, S Abbara. Applied Radiology. 36 (1): January 2007

24 Bicuspid Aortic Valve with Stenosis

25 Sinus of Valsalva Aneurysm Echocardiogram Normal

26 Sinus of Valsalva Aneurysm Echocardiogram Normal

27 NC Sinus of Valsalva Aneurysm

28 R Sinus of Valsalva Aneurysm

29 Undersized Aortic Root replacement resulting in Aortic Cusp Prolaps

30 LV apical conduit Abbara S. Apical aortic Conduit. DI Cardiovascular. Amirsys Inc. 2007

31 LV Apical Conduit

32 Infected Apical Aortic Conduit

33 Infected Apical Aortic Conduit

34 Artificial Valves

35 Mechanical Heart Valves St. Judes Valve in 60yom pre PVI Starr Edwards silastic ball valve

36 St. Judes Mitral Valve Replacement

37 Tilting Disc Valve Abbara S. Prosthetic Cardiac Valves. DI Cardiac. Amirsys Inc. 2007

38 Soni, Abbara. Assessment of vavlular heart disease by CT. In: E Braunwald et al. Harrison s Online. 2008

39 Stuck Valve Courtesy Dr. Stephan Achenbach

40 Stuck Valve Courtesy Dr. Stephan Achenbach

41 Bioprosthesis Abbara S. Prosthetic Cardiac Valves. DI Cardiac. Amirsys Inc. 2007

42 Paravalvular Leak & Pulsating Pseudoaneurysms Abbara S. Prosthetic Cardiac Valves. DI Cardiac. Amirsys Inc. 2007

43 Mitral Valve

44 MR Regurgitant Orifice Planimetry Abbara, Soni, Cury. Seminars in Roentgenology, In press.

45 MS Soni, Abbara. Assessment of vavlular heart disease by CT. In: E Braunwald et al. Harrison s Online. 08

46 SAM

47 SAM

48 HCM S/P Myectomy to treat SAM

49 MV Prolapse ER Ryan, S Abbara, RR Colen, S Arnous, M Quinn, RC Cury, JD Dodd. AJR 2008 in press.

50 Tricuspid Valve

51 Ebsteins anomaly

52 TR

53 TR

54 Carcinoid

55 Carcinoid ER Ryan, S Abbara, JD Dodd. AJR 2008; 190:W294 W303

56 Pulmonic Valve

57 PS

58 PS

59 Thank you!

60 Thank you!

61 MV prolaps (flail leaflet by ECHO)

62 Parachute Mitral Valve Chordae tendinae from both mitral leaflets converge to anterolateral papillary muscle RR Colen, JD Dodd, JB Roedl, RC Cury, S Abbara. Applied Radiology. Volume: 36 Number: 1 January 2007

63 How to Reconstruct Raw Data? Hr = 60bpm 0ms Systole 500ms Diastole 1000ms Hr = 100bpm 0ms Systole Diastole 600ms Abbara et al. AJR 2007; 188(2):

64 AR due to Infective Endocarditis RR Colen, JD Dodd, JB Roedl, RC Cury, S Abbara. Applied Radiology. 36 (1): January 2007

65 Bovouier E, Logeart D, Sablayrolles JL, et al. EHJ 2006 N=30

66 AORTIC VALVULAR FIBROELASTOMA IMAGING: <1.5mm, Short Thin Stalk, Flutters Or Prolapses Atrial Surface Of AV Valves Arterial Surface Of Semilunar Valves Echo: Stippled Or "Shimmering Edge" TREATMENT: Surgical Excision +/ Leaflet Repair Valve Replacement PROGNOSIS: No Recurrence Reported

67 Raoult, Abbara, Jassal. N Engl J Med Feb 15;356(7):715 25

68 Raoult, Abbara, Jassal. N Engl J Med Feb 15;356(7):715 25

69 Raoult, Abbara, Jassal. N Engl J Med Feb 15;356(7):715 25

70 Raoult, Abbara, Jassal. N Engl J Med Feb 15;356(7):715 25

71 Mitral Valve Regurgitation Alkadhi, H. et al. Radiology 2005;238:

72 Alkadhi, H. et al. Radiology 2005;238:

73 Mitral Valve Regurgitation Alkadhi, H. et al. Radiology 2005;238:

74 MR due to Ischemic Dilated Cardiomyopathy RR Colen, JD Dodd, JB Roedl, RC Cury, S Abbara. Applied Radiology. 36 (1): January 2007

75 PAPILLARY FIBROELASTOMA

76 Thank you!

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