Steady‐state free‐precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves

Abstract

Purpose: To assess the diagnostic sensitivity and specificity of double-oblique true fast imaging with steady-state precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves. Materials and Methods:Echocardiograms on patients referred for MRI of the heart and thoracic aorta over a fouryear period were reviewed retrospectively. A total of 17 patients with bicuspid aortic valve were identified and compared to 21 randomly chosen control patients. All patients had double-oblique SSFP (True FISP) cine MRI of the aortic valve independently assessed by two radiologists in a blinded fashion, and graded as bicuspid or normal. Image quality was graded as 1, 2, or 3. Discordance was resolved by consensus.Results: A total of 38 cases were reviewed (27 men, 11 women; age range ϭ 15-67 years, mean ϭ 25.33 years). Interobserver agreement was 0.97 (36/38 cases). One case of normal tricuspid valve was reported as bicuspid by both readers (false-positive). All cases in which disparity arose were rated suboptimal by both readers (grade 2 or 3). Consensus review yielded sensitivity ϭ 100%, specificity ϭ 95.2%, positive predictive value ϭ 94.4%, and negative predictive value ϭ 100%; overall diagnostic accuracy was 97.36%. Interobserver agreement was 0.97. BICUSPID AORTIC VALVE is a common congenital anomaly, with an incidence of 0.9% to 2% in the general population (1). It is associated with aortic stenosis, aortic incompetence, aortic dissection, aneurysm formation (2), infective endocarditis, and aortic coarctation (3). Up to 85% of cases of aortic coarctation have concomitant bicuspid aortic valve morphology (4) and in this group there is a significant association with ascending aortic aneurysm (5). Inheritance may be multifactorial, or autosomal dominant, and is more common in men (6). The diagnosis of bicuspid aortic valve is routinely made using cross sectional two-dimensional (2D) and Doppler echocardiography. Diagnosis is based on the demonstration of two cusps and two commissures during short-axis (SA) visualization. Features such as a single coaptation line between cusps during diastole, cusp redundancy, and eccentric valve closure support the diagnosis. ConclusionMRI is established as one of the most accurate noninvasive modalities in the study of aortic diseases (7,8). Breathhold cine sequences using steady-state free-precession (SSFP) acquisitions, e.g., true fast imaging with steady-state precession (TrueFISP) (Siemens Medical Systems, Erlangen, Germany) combine the advantage of short acquisition times and high signal-to-noise ratio, thus optimizing blood-myocardium contrast (9). Cine sequences are commonly employed to evaluate aortic valve morphology, but the diagnostic accuracy of these sequences in determining aortic valve morphology is unknown.The aim of this study was to determine the sensitivity and specificity of double-oblique TrueFISP cine MRI in distinguishing normal and bicuspid aortic valves when compared with echocardiography as a gold standard. MATERIALS AND METHODSHospital ethics comm...

Measurement of the ascending aorta diameter in patients with severe bicuspid and tricuspid aortic valve stenosis using dual-source computed tomography coronary angiography

“…CMR has been proposed as the preferred imaging modality for the evaluation of the thoracic aorta, particularly AA diameter and coarctation of aorta in patients with BAV [12][13][14][15]. With ECG-gated MDCT, 3D-reconstruction of aorta offers excellent anatomical information about the thoracic aorta including the measurement of AA diameter and depiction of complex aortic anatomy.…”

“…CMR is considered the gold standard for the measurement of aortic diameters [7][8][9][10][11][12][13][14][15]. Adequate TTE views of the mid and distal AA and aortic arch, usually the site of maximum dilatation, can be difficult to obtain in patients with BAV [16].…”

Bicuspid Aortic Valve Is Associated With Altered Wall Shear Stress in the Ascending Aorta

“…Bicuspid cusp morphology has been identified using the steady-state free precession (SSFP) cine imaging. 19 Flowsensitive MRI with full volumetric coverage of the thoracic aorta (4D flow MRI) can measure and visualize aortic 3D blood flow patterns, such as flow jets, vortex, or helical flow patterns. 16,[20][21][22] Moreover, analysis tools have been developed to quantify the distribution of WSS in the entire aorta.…”

Bicuspid Aortic Valve

“…CMRI showed a sensitivity of 100% and a specificity of 95% with steady state freeprecession (SSFP) cine [61]. It seems that CMRI is more reliable than the standard TTE in diagnosing BAV [ Figure 5].…”