Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Diagnostic Performance of Cardiac CT and Transthoracic Echocardiography for Detection of Surgically Confirmed Bicuspid Aortic Valve: Effect of Calcium Extent and Valve Subtypes

외과적으로 확진된 이첨 대동맥 판막의 진단을 위한 심장 CT 및 경흉부 심초음파의 진단적 성능: 판막 아형 및 칼슘의 양이 미치는 효과

  • Jeongju Kim (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sung Mok Kim (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Joonghyun Ahn (Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center) ;
  • Jihoon Kim (Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yeon Hyeon Choe (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김정주 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 김성목 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 안중현 (삼성서울병원 의학통계센터) ;
  • 김지훈 (성균관대학교 의과대학 삼성서울병원 심장뇌혈관병원 이미징센터) ;
  • 최연현 (성균관대학교 의과대학 삼성서울병원 영상의학과)
  • Received : 2022.12.20
  • Accepted : 2023.06.20
  • Published : 2023.11.01
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Abstract

Purpose This study aimed to compare the diagnostic performance of cardiac CT and transthoracic echocardiogram (TTE) depending on the degree of valvular calcification and bicuspid aortic valve (BAV) subtype. Materials and Methods This retrospective study included 266 consecutive patients (106 with BAV and 160 with tricuspid aortic valve) who underwent cardiac CT and TTE before aortic valve replacement. Cardiac CT was used to evaluate the morphology of the aortic valve, and a calcium scoring scan was used to quantify valve calcium. The aortic valves were classified into fused and two-sinus types. The diagnostic accuracy of cardiac CT and TTE was calculated using a reference standard for intraoperative inspection. Results CT demonstrated significantly higher sensitivity, negative predictive value, and accuracy than TTE in detecting BAV (p < 0.001, p < 0.001, and p = 0.003, respectively). The TTE sensitivity tended to decrease as valvular calcification increased. The error rate of TTE for CT was 10.9% for the twosinus type of BAV and 28.3% for the fused type (p = 0.044). Conclusion Cardiac CT had a higher diagnostic performance in detecting BAV than TTE and may help diagnose BAV, particularly in patients with severe valvular calcification.

목적 이첨 대동맥 판막의 아형과 판막 석회화의 정도에 따른 심장 CT와 경흉부심초음파의 이첨 대동맥 판막 진단 능력을 비교해 보고자 한다. 대상과 방법 대동맥 판막 치환술 전 심장 CT와 경흉부 심초음파를 시행한 266명의 환자(이첨 대동맥 판막, 106명; 삼첨 대동맥 판막, 166명)를 후향적으로 포함하였다. 심장 CT를 이용하여 판막의 모양을 평가하였고, 관상동맥 칼슘 측정 CT를 이용하여 판막의 칼슘 정도를 정량화하였다. 대동맥 판막은 융합형과 2-대동맥동형 아형으로 분류하였다. 심장 CT와 경흉부 심초음파의 진단정확도는 수술 소견을 대비표준으로 하여 계산하였다. 결과 CT는 이첨 대동맥 판막을 진단함에 있어서 경흉부 심초음파보다 민감도, 음성 예측도, 정확도에서 통계적으로 유의하게 높은 값을 보여주었다(각각 p < 0.001, p < 0.001, p = 0.003). 경흉부 심초음파는 판막의 석회화가 증가할수록 민감도가 감소하는 경향을 보였다. CT와 경흉부 심초음파 간의 진단 오류율은 2-대동맥동형 아형에서 10.9%, 융합형 아형에서 28.3%였다(p = 0.044). 결론 심장 CT는 이첨 대동맥 판막을 진단함에 있어 경흉부 심초음파보다 높은 진단능을 보여주며, 특히 판막 석회화가 심하거나 융합형의 아형인 환자에서 이첨 대동맥 판막을 진단하는데 도움을 줄 수 있다.

Keywords

Acknowledgement

The illustration was supported by Sungkab Kim, Multimedia Part, Samsung Medical Center.

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