[The use of cross-sectional imaging modalities in the diagnosis of valvular heart disease]. / Einsatz moderner Schnittbildverfahren in der Diagnostik von Herzklappenerkrankungen.

ABSTRACT

Exact visualization of valve morphology seems to be possible with the cross-sectional imaging modalities, magnetic resonance imaging (MRI) and the recently introduced technique of multidetector computed tomography (MDCT). These techniques are used, if other non-invasive imaging modalities, like echocardiography, fail or provide only insufficient information. This commonly occurs in the assessment of right ventricular valves. Quantification of valve stenosis is possible by calculating valve orifice area, which can be performed with MRI and MDCT. An estimation of the instantaneous peak gradient can only be achieved by MR flow measurements. MR flow measurement is a reliable method to quantify the degree of mild to moderate stenoses. Quantification of valve regurgitation is possible by measurement of the regurgitation fraction with MR flow measurements as well as with MR volumetry/CT volumetry. But only the MR flow measurement is suitable for the quantification of valve regurgitation in patients with multiple valves involved or cardiac shunting. MRI and probably MDCT are the most reliable methods in the evaluation of ventricular volumes and therefore suitable for the follow-up in patients with valvular heart disease, because changes in volumes are important for therapeutic decisions in these patients. The crucial advantages of MRI compared to CT in the diagnostic of valvular heart diseases however are the absence of radiation exposure, the possibility of quantitative evaluation of valves function using flow measurements and the higher temporal resolution as compared to MDCT.