European Radiology

, Volume 20, Issue 8, pp 1886–1895

Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies

  • Ronan P. Killeen
  • Samer Arnous
  • Ramon Martos
  • Suhny Abbara
  • Martin Quinn
  • Jonathan D. Dodd
Computed Tomography

Abstract

Objective

To determine whether cardiac computed tomography (MDCT) can differentiate between functional and valvular aetiologies of chronic mitral regurgitation (MR) compared with echocardiography (TTE).

Methods

Twenty-seven patients with functional or valvular MR diagnosed by TTE and 19 controls prospectively underwent cardiac MDCT. The morphological appearance of the mitral valve (MV) leaflets, MV geometry, MV leaflet angle, left ventricular (LV) sphericity and global/regional wall motion were analysed. The coronary arteries were evaluated for obstructive atherosclerosis.

Results

All control and MR cases were correctly identified by MDCT. Significant differences were detected between valvular and control groups for anterior leaflet length (30 ± 7 mm vs. 22 ± 4 mm, P < 0.02) and thickness (3.0 ± 1 mm vs. 2.2 ± 1 mm, P < 0.01). High-grade coronary stenosis was detected in all patients with functional MR compared with no controls (P < 0.001). Significant differences in those with/without MV prolapse were detected in MV tent area (−1.0 ± 0.6 mm vs. 1.3 ± 0.9 mm, P < 0.0001) and MV tent height (−0.7 ± 0.3 mm vs. 0.8 ± 0.8 mm, P < 0.0001). Posterior leaflet angle was significantly greater for functional MR (37.9 ± 19.1° vs. 22.9 ± 14°, P < 0.018) and less for valvular MR (0.6 ± 35.5° vs. 22.9 ± 14°, P < 0.017). Sensitivity, specificity, and positive and negative predictive values of MDCT were 100%, 95%, 96% and 100%.

Conclusion

Cardiac MDCT allows the differentiation between functional and valvular causes of MR.

Keywords

Cardiomyopathy Dilated/complications Mitral valve/anatomy Mitral valve insufficiency/aetiology Computed tomography Coronary artery disease 

Supplementary material

330_2010_1760_MOESM1_ESM.avi (3.7 mb)
Movie IAn 83-year-old woman with progressive dyspnoea. Cardiac MDCT three-chamber multiphasic reconstructions demonstrated marked restriction of the posterior leaflet resulting in a regurgitant orifice (AVI 3.71 MB)
330_2010_1760_MOESM2_ESM.avi (4.8 mb)
Movie IICardiac short axis multiphasic reconstructions in the same patient (as in Movie I) demonstrated regional wall akinesis of the posterolateral segments (AVI 1.97 MB)
330_2010_1760_MOESM3_ESM.avi (2 mb)
Movie IIIA 53-year-old man with progressive dyspnoea. Cardiac MDCT three-chamber multiphasic reconstruction demonstrated thickened mitral valve leaflets (3 mm) with prolapse of the posterior mitral valve leaflet into the left atrium with a resultant mitral regurgitation orifice (AVI 4.82 MB)
330_2010_1760_MOESM4_ESM.avi (2.2 mb)
Movie IVCardiac short axis multiphasic reconstructions in the same patient (as in Movie III) demonstrated normal global and regional wall motion (AVI 2.20 MB)

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Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Ronan P. Killeen
    • 1
  • Samer Arnous
    • 2
  • Ramon Martos
    • 2
  • Suhny Abbara
    • 3
  • Martin Quinn
    • 2
  • Jonathan D. Dodd
    • 1
  1. 1.Department of RadiologySt. Vincent’s University HospitalDublinIreland
  2. 2.Department of CardiologySt. Vincent’s University HospitalDublinIreland
  3. 3.Department of RadiologyMassachusetts General HospitalBostonUSA

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