Role of CT and CMR beyond those provided by echocardiography
| Aortic stenosis | |
| >CT | Imaging of valve if echo window suboptimal Imaging aorta if not seen clearly on echocardiography LV outflow area to improve accuracy of continuity equation if grade uncertain Aortic valve calcium (as a sign of severe aortic stenosis, eg, in low gradient low flow and as a marker of a high risk of events on follow-up) CT/PET to assess calcification and activity Preintervention—coronary anatomy, detection of porcelain aorta, peripheral vessel anatomy, height of coronary artery ostia above the valve |
| CMR | Imaging of valve if echo window suboptimal Imaging aorta if not seen clearly on echocardiography LV mass if required for research, eg, to measure rate of regression after surgery Future possibility of LV fibrosis as a sign suggesting early surgery |
| Aortic regurgitation | |
| CT | Imaging of valve if echo window suboptimal Imaging aorta if not seen clearly on echocardiography |
| CMR | Imaging of valve if echo window suboptimal Imaging aorta if not seen clearly on echocardiography Future possibility of surgery guided by LV volumes and early myocardial fibrosis |
| Mitral valve disease | |
| MS | |
| CT/CMR | Imaging of valve if echo window suboptimal |
| MR | |
| CT | Refining imaging of subvalve apparatus before percutaneous mitral valve procedures Predicting LV outflow tract obstruction after percutaneous mitral valve procedures Quantifying mitral annulus calcification before mitral valve repair |
| CMR | Imaging of valve if echo window suboptimal Future possibility of surgery guided by LV volumes and evidence of early fibrosis |
| Right-sided valve disease | |
| TR | |
| CT | No current indications |
| CMR | RV volumes to guide surgery Tricuspid annulus diameter to guide repair at the same time as left-sided surgery |
| PR | |
| CT | No current indications |
| CMR | Better than echo for imaging the valve and detecting obstruction above or below the valve, and branch artery stenoses Quantification of pulmonary regurgitation Quantification of serial RV volumes to guide surgery |
| Replacement heart valves | |
| CT | Imaging of leaflets or occluder to differentiate patient-prosthesis mismatch from pathological obstruction Detection of pannus |
| CMR | Quantification of regurgitation |
| Endocarditis | |
| CT | Detection of vegetation, eg, on heavily calcified valves May detect aortic root abscess missed by echo Coronary anatomy to avoid invasive angiography before surgery CT/PET to detect endocarditis, eg, on replacement valves or electrical devices |
| CMR | May detect root abscesses missed on echo |
CMR, cardiac magnetic resonance imaging; MS, mitral stenosis; LV, left ventricle; PET, positron emission tomography; PR, pulmonary regurgitation; TR, tricuspid regurgitation; RV, right ventricle.