Factors affecting computed tomography image quality for assessment of mechanical aortic valves

  • Young Joo Suh
  • Young Jin Kim
  • Yoo Jin Hong
  • Hye-Jeong Lee
  • Jin Hur
  • Sae Rom Hong
  • Dong Jin Im
  • Yun Jung Kim
  • Byoung Wook Choi
Original Paper


Evaluating mechanical valves with computed tomography (CT) can be problematic because artifacts from the metallic components of valves can hamper image quality. The purpose of this study was to determine factors affecting the image quality of cardiac CT to improve assessment of mechanical aortic valves. A total of 144 patients who underwent aortic valve replacement with mechanical valves (ten different types) and who underwent cardiac CT were included. Using a four-point grading system, the image quality of the CT scans was assessed for visibility of the valve leaflets and the subvalvular regions. Data regarding the type of mechanical valve, tube voltage, average heart rate (HR), and HR variability during CT scanning were compared between the non-diagnostic (overall image quality score ≤2) and diagnostic (overall image quality score >2) image quality groups. Logistic regression analyses were performed to identify predictors of non-diagnostic image quality. The percentage of valve types that incorporated a cobalt-chrome component (two types in total) and HR variability were significantly higher in the non-diagnostic image group than in the diagnostic group (P < 0.001 and P = 0.013, respectively). The average HR and tube voltage were not significantly different between the two groups (P > 0.05). Valve type was the only independent predictor of non-diagnostic quality. The CT image quality for patients with mechanical aortic valves differed significantly depending on the type of mechanical valve used and on the degree of HR variability.


Cardiac computed tomography Mechanical valves Aortic valve replacement Image quality Valve type 


Compliance with ethical standards

Conflict of interest

All authors declare that there are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived by approval of the Institutional Review Board of Severance Hospital.


  1. 1.
    Bach DS (2010) Echo/Doppler evaluation of hemodynamics after aortic valve replacement: principles of interrogation and evaluation of high gradients. JACC Cardiovasc Imaging 3(3):296–304CrossRefPubMedGoogle Scholar
  2. 2.
    Konen E, Goitein O, Feinberg MS, Eshet Y, Raanani E, Rimon U, Di-Segni E (2008) The role of ECG-gated MDCT in the evaluation of aortic and mitral mechanical valves: initial experience. AJR Am J Roentgenol 191(1):26–31CrossRefPubMedGoogle Scholar
  3. 3.
    LaBounty TM, Agarwal PP, Chughtai A, Bach DS, Wizauer E, Kazerooni EA (2009) Evaluation of mechanical heart valve size and function with ECG-gated 64-MDCT. AJR Am J Roentgenol 193(5):W389–W396CrossRefPubMedGoogle Scholar
  4. 4.
    Tsai IC, Lin YK, Chang Y, Fu YC, Wang CC, Hsieh SR, Wei HJ, Tsai HW, Jan SL, Wang KY, Chen MC, Chen CC (2009) Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard. Eur Radiol 19(4):857–867CrossRefPubMedGoogle Scholar
  5. 5.
    Symersky P, Budde RP, de Mol BA, Prokop M (2009) Comparison of multidetector-row computed tomography to echocardiography and fluoroscopy for evaluation of patients with mechanical prosthetic valve obstruction. Am J Cardiol 104(8):1128–1134CrossRefPubMedGoogle Scholar
  6. 6.
    Habets J, Mali WP, Budde RP (2012) Multidetector CT angiography in evaluation of prosthetic heart valve dysfunction. Radiographics 32(7):1893–1905CrossRefPubMedGoogle Scholar
  7. 7.
    Habets J, Symersky P, van Herwerden LA, de Mol BA, Spijkerboer AM, Mali WP, Budde RP (2011) Prosthetic heart valve assessment with multidetector-row CT: imaging characteristics of 91 valves in 83 patients. Eur Radiol 21(7):1390–1396CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Park YJ, Kim YJ, Lee JW, Kim HY, Hong YJ, Lee HJ, Hur J, Nam JE, Choi BW (2012) Automatic tube potential selection with tube current modulation (APSCM) in coronary CT angiography: comparison of image quality and radiation dose with conventional body mass index-based protocol. J Cardiovasc Comput Tomogr 6(3):184–190CrossRefPubMedGoogle Scholar
  9. 9.
    Suh YJ, Kim YJ, Hong SR, Hong YJ, Lee HJ, Hur J, Choi BW (2013) Combined use of automatic tube potential selection with tube current modulation and iterative reconstruction technique in coronary CT angiography. Radiology 269(3):722–729CrossRefPubMedGoogle Scholar
  10. 10.
    van der Schaaf I, van Leeuwen M, Vlassenbroek A, Velthuis B (2006) Minimizing clip artifacts in multi CT angiography of clipped patients. AJNR Am J Neuroradiol 27(1):60–66PubMedGoogle Scholar
  11. 11.
    Boas FE, Fleischmann D (2011) Evaluation of two iterative techniques for reducing metal artifacts in computed tomography. Radiology 259(3):894–902CrossRefPubMedGoogle Scholar
  12. 12.
    Symersky P, Budde RP, Prokop M, de Mol BA (2011) Multidetector-row computed tomography imaging characteristics of mechanical prosthetic valves. J Heart Valve Dis 20(2):216–222PubMedGoogle Scholar
  13. 13.
    Symersky P, Budde RP, Westers P, de Mol BA, Prokop M (2011) Multidetector CT imaging of mechanical prosthetic heart valves: quantification of artifacts with a pulsatile in vitro model. Eur Radiol 21(10):2103–2110CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Symersky P, Habets J, Westers P, de Mol BA, Prokop M, Budde RP (2012) Prospective ECG triggering reduces prosthetic heart valve-induced artefacts compared with retrospective ECG gating on 256-slice CT. Eur Radiol 22(6):1271–1277CrossRefPubMedGoogle Scholar
  15. 15.
    Rist C, Johnson TR, Muller-Starck J, Arnoldi E, Saam T, Becker A, Leber AW, Wintersperger BJ, Becker CR, Reiser MF, Nikolaou K (2009) Noninvasive coronary angiography using dual-source computed tomography in patients with atrial fibrillation. Invest Radiol 44(3):159–167CrossRefPubMedGoogle Scholar
  16. 16.
    Sun Z, Ng KH (2012) Prospective versus retrospective ECG-gated multislice CT coronary angiography: a systematic review of radiation dose and diagnostic accuracy. Eur J Radiol 81(2):e94–e100CrossRefPubMedGoogle Scholar
  17. 17.
    Kim HY, Lee JW, Hong YJ, Lee HJ, Hur J, Nam JE, Choi BW, Kim YJ (2012) Dual-source coronary CT angiography in patients with high heart rates using a prospectively ECG-triggered axial mode at end-systole. Int J Cardiovasc Imaging 28(Suppl 2):101–107CrossRefPubMedGoogle Scholar
  18. 18.
    Chenot F, Montant P, Goffinet C, Pasquet A, Vancraeynest D, Coche E, Vanoverschelde JL, Gerber BL (2010) Evaluation of anatomic valve opening and leaflet morphology in aortic valve bioprosthesis by using multidetector CT: comparison with transthoracic echocardiography. Radiology 255(2):377–385CrossRefPubMedGoogle Scholar
  19. 19.
    Horiguchi J, Fujioka C, Kiguchi M, Yamamoto H, Kitagawa T, Kohno S, Ito K (2009) Prospective ECG-triggered axial CT at 140-kV tube voltage improves coronary in-stent restenosis visibility at a lower radiation dose compared with conventional retrospective ECG-gated helical CT. Eur Radiol 19(10):2363–2372CrossRefPubMedGoogle Scholar
  20. 20.
    Wilting JE, Timmer J (1999) Artefacts in spiral-CT images and their relation to pitch and subject morphology. Eur Radiol 9(2):316–322CrossRefPubMedGoogle Scholar
  21. 21.
    Yang WJ, Pan ZL, Zhang H, Pang LF, Guo Y, Chen KM (2011) Evaluation of coronary artery in-stent restenosis with prospectively ECG-triggered axial CT angiography versus retrospective technique: a phantom study. Radiol Med 116(2):189–196CrossRefPubMedGoogle Scholar
  22. 22.
    Habets J, Symersky P, Leiner T, de Mol BA, Mali WP, Budde RP (2012) Artifact reduction strategies for prosthetic heart valve CT imaging. Int J Cardiovasc Imaging 28(8):2099–2108CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Sucha D, Willemink MJ, de Jong PA, Schilham AM, Leiner T, Symersky P, Budde RP (2014) The impact of a new model-based iterative reconstruction algorithm on prosthetic heart valve related artifacts at reduced radiation dose MDCT. Int J Cardiovasc Imaging 30(4):785–793CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Young Joo Suh
    • 1
  • Young Jin Kim
    • 1
  • Yoo Jin Hong
    • 1
  • Hye-Jeong Lee
    • 1
  • Jin Hur
    • 1
  • Sae Rom Hong
    • 1
  • Dong Jin Im
    • 1
  • Yun Jung Kim
    • 1
  • Byoung Wook Choi
    • 1
  1. 1.Department of Radiology, Research Institute of Radiological Science, Severance HospitalYonsei University College of MedicineSeoulKorea

Personalised recommendations