Assessment of the anatomic regurgitant orifice in aortic regurgitation: a clinical magnetic resonance imaging study.
BACKGROUND
The aim of our study was to determine whether planimetry of the anatomic regurgitant orifice (ARO) in patients with aortic regurgitation (AR) by magnetic resonance imaging (MRI) is feasible and whether ARO by MRI correlates with the severity of AR.


RESULTS
Planimetry of ARO by MRI was performed on a clinical magnetic resonance system (1.5 T Sonata, Siemens Medical Solutions) in 45 patients and correlated with the regurgitant fraction (RgF) and regurgitant volume (RgV) determined by MRI phase velocity mapping (PVM; MRI-RgF, MRI-RgV, n = 45) and with invasively quantified AR by supravalvular aortography (n = 32) and RgF upon cardiac catheterisation (CATH-RgF, n = 15). Determination of ARO was possible in 98% (44/45) of the patients with adequate image quality. MRI-RgF and CATH-RgF were modestly correlated (n = 15, r = 0.71, p<0.01). ARO was closely correlated with MRI-RgF (n = 44, r = 0.88, p<0.001) and was modestly correlated with CATH-RgF (n = 14, r = 0.66, p = 0.01). Sensitivity and specificity of ARO to detect moderately severe and severe aortic regurgitation (defined as MRI-RgF > or =40%) were 96% and 95% at a threshold of 0.28 cm2 (AUC = 0.99). Of note, sensitivity and specificity of ARO to detect moderately severe and severe AR at catheterisation (defined as CATH-RgF > or =40% or supravalvular aortography > or =3+) were 90% and 91% at a similar threshold of 0.28 cm2 (AUC = 0.95). Lastly, sensitivity and specificity of ARO to detect severe aortic regurgitation (defined as MRI-RgF > or =50% and/or regurgitant volume > or =60 ml) were 83% and 97% at a threshold of 0.48 cm2 (AUC = 0.97).


CONCLUSIONS
Visualisation and planimetry of the ARO in patients with AR are feasible by MRI. There is a strong correlation of ARO with RgV and RgF assessed by PVM and with invasively graded AR at catheterisation. Therefore, determination of ARO by MRI is a new non-invasive measure for assessing the severity of AR.
Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität, Regensburg, Germany. kurt.debl@klinik.uni-regensburg.de
K
K
Debl
B
B
Djavidani
S
S
Buchner
N
N
Heinicke
S
S
Fredersdorf
J
J
Haimerl
F
F
Poschenrieder
S
S
Feuerbach
G A J
GA
Riegger
A
A
Luchner
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000175:diagnosis*; D006328:Cardiac Catheterization / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged