Aortic valvular calcification and severity of aortic stenosis

This article by Liu F et al in the February issue of the AJR, shows how aortic valvular calcification on chest CT can predict the severity of aortic stenosis. Increasing calcification (as measured by the Agatston score) and the presence of calcification in the central right-left and peripheral left posterior commissures correlated with increased severity and gradients, as measured on echocardiography and color Doppler.

Interestingly, the study is on patients using standard 5mm collimation plain CT, without ECG-gating on a 4-slice scanner. If the information obtained on a relatively crude study can be so useful, with 64-slice scanners, plain CT chest scans should be able to yield more information and cardiac CT scans even more. It also means that it may be a good idea to look at aortic valvular calcification on routine CT chests.

This is a 66-years old man with known aortic stenosis (gradient of 50), who presented for a cardiac CT to rule out coronary artery disease. His coronaries were normal, but the CT showed calcification in all three commissures (Fig. 1), with moderate stenosis, appreciated well on the the cine files (transaxial and LVOT views)

Download aortic_valve_calcification_02.avi

Download aortic_valve_calcification_01.avi

Comments

[ravi bathina]

My experience for LA appendage thrombus has been rather disappointing with CMR.

What is the experience with CTA ?

[Bhavin]

Have published one case on this site - http://bhavin.typepad.com/cardiac_images/2006/01/left_atrial_app.html, showing a LAA thrombus with CT. Since we haven't had too many cases, I can't say for sure, but I think, we should be able to make out thrombi reasonably well.