Koo Hyun Jung, Kang Joon-Won, Kim Jeong A, Kim Joon Bum, Jung Sung-Ho, Choo Suk Jung, Chung Cheol Hyun, Lee Jae Won, Lim Tae-Hwan, Yang Dong Hyun
Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, 411-706, Republic of Korea.
Int J Cardiovasc Imaging. 2018 Aug;34(8):1295-1303. doi: 10.1007/s10554-018-1341-1. Epub 2018 Mar 21.
In patients with aortic regurgitation (AR), a precise preoperative assessment of aortic valve (AV) pathology is important if AV repair or sparing operation is an alternative option. The aim of this study was to assess the diagnostic accuracy of computed tomography (CT) for evaluating the AR mechanism compared with surgical inspection. 59 patients with AR who underwent AV surgery and preoperative cardiac CT were evaluated. AR mechanism was classified into type 1 (aortic dilatation or cusp perforation), type 2 (prolapsed cusp) and type 3 (cusp retraction). Agreement between CT and surgical inspection was obtained. Correlation between aortic regurgitant orifice (ARO) and imaging parameters were evaluated. On surgical inspection, type 1 AR was noted in 22 patients, type 2 in 16 and type 3 in 21. Agreement regarding the AR mechanism on CT was excellent (intra-class correlation coefficient, 0.81). At the patient level, the Cohen's κ value for CT findings with surgical inspection was of 0.89. At the cusp level, moderate agreement was noted between CT and surgical inspection. In the per-cusp analysis, CT had a sensitivity of 72.6%, specificity of 85.1%, positive predictive value of 73.8% and negative predictive value of 84.3% for the detection of aortic cusp abnormality. The diameter, perimeter and area of aortic annulus had moderate correlation with ARO (r = 0.54-0.66, P < 0.001). CT-derived classification of AR mechanism showed excellent agreement with surgical inspection.
对于主动脉瓣关闭不全（AR）患者，如果主动脉瓣（AV）修复或保留手术是一种替代选择，那么术前对主动脉瓣病变进行精确评估至关重要。本研究的目的是评估计算机断层扫描（CT）与手术检查相比在评估AR机制方面的诊断准确性。对59例接受AV手术和术前心脏CT检查的AR患者进行了评估。AR机制分为1型（主动脉扩张或瓣叶穿孔）、2型（瓣叶脱垂）和3型（瓣叶回缩）。得出了CT与手术检查之间的一致性。评估了主动脉反流口（ARO）与影像参数之间的相关性。手术检查发现，22例患者为1型AR，16例为2型，21例为3型。CT上关于AR机制的一致性极佳（组内相关系数，0.81）。在患者层面，CT检查结果与手术检查的Cohen's κ值为0.89。在瓣叶层面，CT与手术检查之间存在中度一致性。在每个瓣叶的分析中，CT检测主动脉瓣叶异常的敏感性为72.6%，特异性为85.1%，阳性预测值为73.8%，阴性预测值为84.3%。主动脉瓣环的直径、周长和面积与ARO具有中度相关性（r = 0.54 - 0.66，P < 0.001）。CT得出的AR机制分类与手术检查显示出极佳的一致性。
