title: Cardiac CT angiography for the diagnosis of mitral valve prolapse: comparison with echocardiography1.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of coronary computed tomographic (CT) angiography for the diagnosis of mitral valve prolapse (MVP).
  
  
  METHODS
  The retrospective case-controlled multicenter study protocol was approved by the institutional review boards. The U.S. part of the study was HIPAA compliant. One hundred twelve patients who underwent electrocardiographically gated 64-section coronary CT angiography (n = 60) or dual-source coronary CT angiography (n = 52) and transthoracic echocardiography (TTE) were included. Fifty-three patients with MVP were matched for age and sex with 59 patients without MVP. CT images were analyzed on three-, two-, and four-chamber (CH) views by two independent observers. MVP was defined as a greater than 2-mm displacement of leaflets below the annulus plane and was subclassified as "billowing" (bowing) or "flail leaflet" (free leaflet margin displacement). Leaflet thickness was measured and defined as thickened if it was greater than 2 mm.
  
  
  RESULTS
  The diagnostic performance of CT when three- and two-CH views were combined for the diagnosis of MVP was as follows: sensitivity, 96%; specificity, 93%; positive predictive value (PPV), 93%; and negative predictive value, 96%. On four-CH views, the excursion of billowing was higher than it was on three-CH views (P <.001), and the PPV of the four-CH view for diagnosis of MVP was 89%. The correlation between CT and TTE for excursion of billowing was high (r = 0.80-0.91). In a subset of 32 patients, the agreement between CT and TTE for differentiation of billowing (n = 13) and flail leaflet (n = 2) was 100%. Leaflet thickening was more prevalent in patients with MVP than it was in those without (71% vs 20%, P <.001), and correlation with TTE was good (r = 0.81 [anterior leaflet] and 0.77 [posterior leaflet]).
  
  
  CONCLUSIONS
  The combined use of three- and two-CH views allows an accurate diagnosis of MVP at coronary CT angiography.
authors.affiliation: Department of Radiology II, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria. Gudrun.Feuchtner@i-med.ac.at
authors.forename: Gudrun M
authors.initials: GM
authors.lastname: Feuchtner
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Christoph
authors.initials: C
authors.lastname: Karlo
authors.forename: Ammar
authors.initials: A
authors.lastname: Sarwar
authors.forename: Andreas
authors.initials: A
authors.lastname: Meier
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dichtl
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Juerg
authors.initials: J
authors.lastname: Gruenenfelder
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
mesh_terms: D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed