Table 1

Role of CT and CMR beyond those provided by echocardiography

Aortic stenosis
 >CTImaging 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
 CMRImaging 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
 CTImaging of valve if echo window suboptimal
Imaging aorta if not seen clearly on echocardiography
 CMRImaging 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/CMRImaging of valve if echo window suboptimal
 MR
  CTRefining 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
  CMRImaging of valve if echo window suboptimal
Future possibility of surgery guided by LV volumes and evidence of early fibrosis
Right-sided valve disease
 TR
  CTNo current indications
  CMRRV volumes to guide surgery
Tricuspid annulus diameter to guide repair at the same time as left-sided surgery
 PR
  CTNo current indications
  CMRBetter 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
 CTImaging of leaflets or occluder to differentiate patient-prosthesis mismatch from pathological obstruction
Detection of pannus
 CMRQuantification of regurgitation
Endocarditis
 CTDetection 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
 CMRMay 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.