| Part 1. Assessment of the normal mitral valve with 320-slice volume CT1. Objective To assess the value of 320-detector volume CT in observing normal mitral valve.2. Methods(1) Collected fifty normal adults without abnormality of heart from April 2010 to June 2010 underwent 320-detector volume CT scan.35 cases were male and 15 cases were female, the oldest was 76 years and the youngest was 40 years, the average age was (57.8±7.1)years. All subjects were without renal insufficiency(Cr≤1.2mg/L).Routine echocardioguaphy, electrocardiogram(ECG) and chest radiographic were normal, and coronary angiography showed no stenosis and variation.(2)Use Toshiba Aquilion One 320 row volume for plain and enhanced CT scan. The subjects were supine position, feet first direction, scanning from the carina covering to about 1cm at the diaphragm with total heart volume scan. Contrast agent(Ultracist, 370 mgI/m1)70ml was injected from the cubital vein, for the rate of 5.0ml/s, and then injecting saline 20ml with the same rate. Sure Start was triggered by intelligent scanning software. The trigger point set at the central level of the descending aorta scan field with the threshold of 180HU. Subjects adopted image with retrospective ECG-gated technology in the whole cardiac cycle.(3) Image post-processing and analysis: Reconstruct the entire cardiac cycle volume data collected by retrospective ECG-gated technology using the functional analysis software. This data included 10 cardiac cycle phases such as 0,10%, 20%, 30%, 40%, 50%, 60%,70%, 80% and 90% .The images of 10 phases were transferred to the workstation(VitreaⅡfx) for reconstruct. Analysis of heart function (cardiac function) software set at three levels, namely, the left ventricular long axis perpendicular to the interventricular septum(IVS), left ventricular long axis parallel to the IVS and left ventricular short axis. The length and thickness of the mitral valve, diameter and area of the mitral annulus, diameter of the mitral valve (the shortest distance cusps) and the area and the mitral valve and the open angle of the before and after flap were measured in the MPR and MIP images of the Horizontal long axis and short axis. The MV opening angle was formed difference from systolic and diastolic of the MV, with the mitral annulus to the bottom, the base of the MV to apex and the MV body to another side. Mitral annulus and MV orifice were sketched in the short axis of the heart, and measured their diameters and areas. The measurement results were analyzed by compared with the gross anatomical measurement and echocardiography. Multi-phase images were made into a movie in the left ventricular long-axis. Observe the movement of the MV and its subsidiary structure.(4)The instrument of the echocardiography was the GE VIVID7 mode color Doppler ultrasonic diagnostic apparatus with frequency of 2.5MHZ. The length of MV, diameter and area of mitral orifice, diameter of the mitral annual and the opening angle of the MV were measure at the cardiac long axis, short axis of the LV and the short axis of the aortic. The above data were collected by two deputy director of ultrasound independently. 3.Results The length of anterior and posterior mitral was (25.91±4.70)mm and (13.19±2.52)mm, respectively. The height of anterior and posterior mitral was (1.97±0.05)mm and (1.13±0.03)mm, respectively. The length of anterior and posterior mitral annulus was (39.14±6.84)mm and(81.50±9.90)mm, respectively. The maximal diameter and area of the MV mouth was (18.90±3.12)mm and (413.44±69.92)mm~2, respectively. Correspondingly, the diameter of mitral annulus was (31.89±5.78) mm [M:(31.93±3.45)mm,F:(29.97±3.28)mm] and (823.94±114.17)mm~2. The maximal open angle was (63.26±12.03)°and (53.54±10.35)°for the anterior and posterior valves respectively. Comparing of the anatomical literature,the measurement of 320-sclie volume CT had statistically significant difference. There was significant statistical difference compared the measurement of 320CT with anatomy. The length of right coronary valve, no coronary valve, AV mouth area, AV annulus diameter and the aortic ratio had good correlation between the 320-scile volume CT and ultrasound, the correlation coefficients were 0.97,0.95,0.93,0.97 and 0.91.Bland-Altman analysis showed that the measurement of 320 row volume CT had good consistency with the echocardiography. The differences of the measurement of 320 row volume CT and ultrasound in the length of the MV, diameter and area of the mitral orifice and diameter of the mitral annular were 0.13mm, 0.15mm, 0.22mm, 2.53mm~2 and 0.06mm, The scope of consistency limits of the two methods were 1.39～-1.13mm, 0.93～-0.63mm, 1.38～-0.90mm, 19.42～-14.40mm~2 and 2.71～-2.60mm.4.Conclusion The 320-slice volume CT can analyze the morphology and function of mitral valve, being effective to evaluate the normal mitral valve.Part2. Assessment of the normal aortic valve with 320-slicevolume CT 1. Objective To observe the value of 320-slice volume CT in diagnosing and evaluating the normal aortic valve.2. Methods(1) Collected 100 normal adults without abnormality of heart from April 2010 to November 2010 underwent 320-detector volume CT scan.48 cases were male and 52 cases were female, the oldest was 76 years and the youngest was 28 years, the average age was (57.4±7.1)years. All subjects were without renal insufficiency(Cr≤1.2mg/L).Routine echocardiography, electrocardiogram(ECG) and chest radiographic were normal, and coronary angiography showed no stenosis and variation. (2)Use Toshiba Aquilion One 320 slice volume for plain and enhanced CT scan. The subjects were supine position, feet first direction, scanning from the carina covering to about 1cm at the diaphragm with total heart volume scan. Contrast agent(Ultracist, 370 mgI/m1)70ml was injected from the cubital vein, for the rate of 5.0ml/s, and then injecting saline 20ml with the same rate. Sure Start was triggered by intelligent scanning software. The trigger point set at the central level of the descending aorta scan field with the threshold of 180HU. Subjects adopted image with retrospective ECG-gated technology in the whole cardiac cycle.(3) Image post-processing and analysis: Reconstruct the entire cardiac cycle volume data collected by retrospective ECG-gated technology using the functional analysis software. This data included 10 cardiac cycle phases such as 0,10%, 20%, 30%, 40%, 50%, 60%,70%, 80% and 90% .The images of 10 phases were transferred to the workstation(VitreaⅡfx) for reconstruct. Long and short axial of the LV were setting manually in the cardiac function software corresponding echocardiography. Observe the shape, opening and closing of the AV from different angles and time. The length and thickness were measured in the long axis of LV. The areas of the AV orifice (AV orifice is triangular, no evaluation of the diameter), the diameter, area and aortic ratio (aortic=diameter of aortic sinus ridge tube/diameter of proximal aortic; aortic sinus ridge tube was the junction of the aortic sinus with the aorta, diameter of the proximal aortic were measured at the level of the pulmonary artery bifurcation). Valve length, sinus high was measured in the vertical levels of the AV. Coronary-ring distant was the diameter from the mouth of the coronary artery to the aortic annulus at the base of the plain through the mouth of the coronary artery. All measurements are the average of measurements in 3 times acquired by the same researcher. The measurement results were analyzed by compared with the gross anatomical measurement and echocardiography. Multi-phase images were made into a movie in the left ventricular long-axis. Observe the movement of the AV and its subsidiary structure.(4)The instrument of the echocardiography was the GE VIVID7 mode color Doppler ultrasonic diagnostic apparatus with frequency of 2.5MHZ. The length of the right AV, no coronary valve, area of the AV orifice, diameter of the aortic annulus and the aortic ratio were measured at the LV long axis and short axis used M mode ultrasound. The above data were collected by two deputy director of ultrasound independently.3.Results The length of the aortic valves are (L: 12.02±0.84)mm,(R: 12.18±0.82)mm and(N: 13.1±0.60)mm,and height of the aortic valves are(L: 1.84±0.28)mm,(R: 1.76±0.27)mm and(N: 1.93±0.31)mm. The maximal aortic area appeared in late systolic, with a value of (241.76±16.85)mm~2.The maximal diameter and area of aortic ring appeared in early systolic, with a value of (21.43±1.25)mm, (380.27±31.57)mm[M:(384.27±31.57)mm,F:(365.31±32.37)mm~2]. The aortic ratio is 0.86±0.04. The height of aortic sinus have no statistical difference, with a value of (R: 18.00±2.75)mm,(L: 18.28±2.28)mm and(N: 18.45±2.55)mm . The distances from the coronary artery root to the aortic ring are (L: 15.54±1.91)mm and(R: 14.40±2.93)mm respectively. Comparing of the anatomical literature , the measurement of 320-sclie volume CT had statistically significant difference. The length of right coronary valve, no coronary valve, AV area, aortic valve annulus diameter and the aortic ratio had good correlation between the 320-scile volume CT and ultra sound, the correlation coefficients were 0.80, 0.73, 0.84, 0.76 and 0.83. Bland-Altman analysis showed that the measurement of 320 slice volume CT had good consistency with the echocardiography. The differences of the measurement of 320 slice volume CT and ultrasound in the length of the right AV, no coronary valve, area of the AV orifice, diameter of the aortic annulus and the aortic ratio were 0.37mm,-0.85mm, 10.87mm, 1.25mm, and 0.007, respectively, two methods are consistent range of 1.50～-0.75mm, 2.05～-0.34mm, 33.56～-11.81mm, 3.63～-1.13mm and 0.06～-0.40. 4. Conclusions 320-slice volume CT is the effective way to diagnose and evaluate the normal aortic valve.Part 3. Assessment of the disease of mitral valve and aortic valve with 320 slice volume CT: a comparison with transthoracic echocardiography.1. Objective: To investigate the value of the volume of 320 slice volume CT in diagnosing and evaluating the mitral and aortic valve disease.2. Methods:(1)select the patients with suspected MV and AV disease in 14 cases, for MV disease 10 cases and AV disease 4 cases, from April 2010 to November 2010 in our hospital. There are 5 cases of mitral stenosis, 4 of mitral regurgitation, 4 of aortic regurgitation, one of mitral and aortic regurgitation. There are 4 males and 10 females, aged 40 to 55 years, mean(45.8±5.7)years. All subjects are without renal insufficiency(Cr≤1.2mg/L).(2)Use Toshiba Aquilion One 320 row volume for plain and enhanced CT scan. The subjects were supine position, feet first direction, scanning from the carina covering to about 1cm at the diaphragm with total heart volume scan. Contrast agent(Ultracist, 370 mgI/m1)70ml was injected from the cubital vein, for the rate of 5.0ml/s, and then injecting saline 20ml with the same rate. Sure Start was triggered by intelligent scanning software. The trigger point set at the central level of the descending aorta scan field with the threshold of 180HU. Subjects adopted image with retrospective ECG-gated technology in the whole cardiac cycle.(3) Image post-processing and analysis: Reconstruct the entire cardiac cycle volume data collected by retrospective ECG-gated technology using the functional analysis software. This data included 10 cardiac cycle phases such as 0,10%, 20%, 30%, 40%, 50%, 60%,70%, 80% and 90% .The images of 10 phases were transferred to the workstation(VitreaⅡfx) for reconstruct. Analysis of heart function (cardiac function) software set at three levels, namely, the left ventricular long axis perpendicular to the interventricular septum(IVS), left ventricular long axis parallel to the IVS and left ventricular short axis. Observed the MV and AV in different plane and measured the length, thickness and opening angle of the MV as well as the area of MV orifice. Measure the length, thickness of the MV, area of aortic hole and the aortic ratio too. Multi-phase images were made into a movie in the left ventricular long-axis. Observe the movement of the MV and AV and their subsidiary structure through the MIP, Colored lit and VRT.(4)The instrument of the echocardiography was the GE VIVID7 mode color Doppler ultrasonic diagnostic apparatus with frequency of 2.5MHZ. Observe and measure the length of MV, area of MV orifice and mouth in cardiac long axis, short axis of left ventricular and aortic short axis. This work was done by two deputy director of ultrasound independently.3. ResultsThe mitral and aortic valve diseases can be observed at different levels with 320 slice volume CT (Figure7-9). For 5 cases were diagnosed mitral stenosis, 4 were mitral regurgitation, 4 were aortic regurgitation and 1 mitral and aortic regurgitation. There were 4 cases were diagnosed mitral stenosis. 4 were mitral regurgitation, 3 were aortic regurgitation and 1 was mitral and aortic regurgitation. One patient can not be diagnosed by echocardiography due to severe COPD. The result of 320 slice volume CT and echocardiography show no significant difference analyzed by chi-square text(Χ2test).4. ConclusionThe mitral valve and aortic valve disease can be analyzed quantitatively by 320 slice volume CT, and it is an effective way to diagnosis and evaluate the mitral valve and aortic valve disease. |
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