title: Detection of Björk-Shiley convexo-concave heart valve outlet strut single leg separations: consensus image acquisition and interpretation using two different cineradiographic imaging technologies.
abstract: BACKGROUND
  Conventional cineradiology has been used clinically to detect partially broken outlet struts (single leg separations, SLSs) in normally functioning Björk-Shiley convexo-concave (C/C) heart valves. The value of radiographic screening has, however, been debated in the medical literature. This study uses the same radiographic technique in sheep implanted with known-status C/C valves in combination with a newly developed geometric image magnification radiography system. This study was designed to test whether sensitivity and specificity of radiographic screening of C/C valves in detecting SLSs could be improved through the combination of readers and imaging modalities.
  
  
  METHODS
  Twenty-one sheep with mitral C/C valves were studied on both systems. Five were used for extensive scanning training. When operators were expert on both systems, 16 blinded study valves (4 intact and 12 with outlet strut SLSs) were scanned twice on both systems, first on a modified conventional and then a prototype geometric image magnification (Feinfocus(TM)) cineradiographic system by two expert physicians working together.
  
  
  RESULTS
  Among the 32 scanned valves, the two combined expert physicians were required to evaluate 40 intact legs and 24 with an SLS. For all SLS valves, the conventional and Feinfocus systems separately detected 50 (12/24) and 54% (13/24), respectively. When the two systems were combined, the final consensus score was correct in 67% (16/24) of all SLS valves.
  
  
  CONCLUSIONS
  Combined modality, paired expert physicians detected 67% of all SLSs. The Feinfocus system might be best reserved for those patients in whom the Siemens screening study demonstrates in minimally suspicious (grade 2) or suspicious (grade 3) appearance of a C/C valve outlet strut leg.
authors.affiliation: Department of Radiology, Department of Medicine, Penn State University, Hershey, Penn. 17033, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Hopper
authors.forename: I C
authors.initials: IC
authors.lastname: Gilchrist
authors.forename: J R
authors.initials: JR
authors.lastname: Landis
authors.forename: A R
authors.initials: AR
authors.lastname: Localio
authors.forename: R P
authors.initials: RP
authors.lastname: Wilson
authors.forename: W E
authors.initials: WE
authors.lastname: Pae
authors.forename: A R
authors.initials: AR
authors.lastname: Kunselman
authors.forename: J W
authors.initials: JW
authors.lastname: Griffith
authors.forename: W S
authors.initials: WS
authors.lastname: Pierce
authors.forename: P S
authors.initials: PS
authors.lastname: Potok
authors.forename: T R
authors.initials: TR
authors.lastname: TenHave
mesh_terms: D000818:Animals; D002933:Cineradiography; D004195:Disease Models, Animal; D006350:Heart Valve Prosthesis; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D008991:Monitoring, Physiologic / Q000379:methods; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012680:Sensitivity and Specificity; D012756:Sheep