title: Cardiac CT for the differentiation of bicuspid and tricuspid aortic valves: comparison with echocardiography and surgery.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the diagnostic performance of CT, compared with that of echocardiography and surgery, for differentiating between bicuspid and tricuspid aortic valves.
  
  
  METHODS
  Forty-seven patients with bicuspid valve and 47 patients with tricuspid aortic valve underwent retrospectively ECG-gated dual-source CT and echocardiography. Thirty-four (72%) of the 47 patients with bicuspid aortic valve underwent valve surgery. Two independent blinded observers assessed the CT image quality of the aortic valve during diastole and systole on a 4-point scale, determined which phase allowed the differentiation of valve type, distinguished between tricuspid and bicuspid aortic valves, and assessed for the presence of a raphe. Diagnostic performance of CT was determined using echocardiography and surgery as the reference standard.
  
  
  RESULTS
  According to echocardiography and surgery, seven (15%) of the 47 bicuspid aortic valves had no raphe, and 40 (85%) had a raphe. CT image quality was diagnostic (i.e., scores of 1-3) in all 94 patients in both diastole and systole. Among patients with bicuspid aortic valve and no raphe, differentiation between tricuspid and bicuspid aortic valves could be performed in diastole in 100% (7/7) of cases. Among patients with bicuspid aortic valve and raphe, differentiation was possible only in systole in 5% (2/40) of cases and when combining diastole and systole in 95% (38/40) of cases. In three bicuspid aortic valves with raphe, the valve was misclassified by CT as tricuspid aortic valve. Overall sensitivity and specificity of CT for the diagnosis of bicuspid aortic valve were 94% and 100%.
  
  
  CONCLUSIONS
  CT is highly accurate for differentiation between bicuspid and tricuspid aortic valves. For bicuspid aortic valves without raphe, diastolic reconstructions are sufficient, whereas in those with a raphe, additional reconstructions in systole are required.
authors.affiliation: Institute of Diagnostic Radiology, University Hospital, Zurich, Switzerland.
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Trindade
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: André
authors.initials: A
authors.lastname: Plass
authors.forename: Stephan
authors.initials: S
authors.lastname: Baumueller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult