J Korean Soc Radiol.  2023 Nov;84(6):1324-1336. 10.3348/jksr.2022.0170.

Diagnostic Performance of Cardiac CT and Transthoracic Echocardiography for Detection of Surgically Confirmed Bicuspid Aortic Valve: Effect of Calcium Extent and Valve Subtypes

• Kim J
• Kim SM
• Ahn J
• Kim J
• Choe YH

• KMID: 2548561
• DOI: http://doi.org/10.3348/jksr.2022.0170

Abstract

Purpose
This study aimed to compare the diagnostic performance of cardiac CT and transthoracic echocardiogram (TTE) depending on the degree of valvular calcification and bicuspid aortic valve (BAV) subtype.
Materials and Methods
This retrospective study included 266 consecutive patients (106 with BAV and 160 with tricuspid aortic valve) who underwent cardiac CT and TTE before aortic valve replacement. Cardiac CT was used to evaluate the morphology of the aortic valve, and a calcium scoring scan was used to quantify valve calcium. The aortic valves were classified into fused and two-sinus types. The diagnostic accuracy of cardiac CT and TTE was calculated using a reference standard for intraoperative inspection.
Results
CT demonstrated significantly higher sensitivity, negative predictive value, and accuracy than TTE in detecting BAV (p < 0.001, p < 0.001, and p = 0.003, respectively). The TTE sensitivity tended to decrease as valvular calcification increased. The error rate of TTE for CT was 10.9% for the twosinus type of BAV and 28.3% for the fused type (p = 0.044).
Conclusion
Cardiac CT had a higher diagnostic performance in detecting BAV than TTE and may help diagnose BAV, particularly in patients with severe valvular calcification.

Keyword

Bicuspid Aortic Valve Disease; Aortic Valve Disease; Aortic Valve, Calcification of; Multidetector Computed Tomography; Echocardiography