What is the role of cardiac CT scanning and MRI in the workup of aortic regurgitation (AR)?

Updated: Nov 19, 2018
  • Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Cardiac computed tomography (CT) scanning and magnetic resonance imaging (MRI) have not yet achieved widespread adoption in the management of AR, although support in the literature is increasing for the potential clinical use of these imaging techniques. [29, 30, 31]

In a study that used quantitative flow measurement by cardiac MRI (CMR) with calculation of regurgitant fraction (RF) to assess aortic regurgitation (AR), Orwat et al found that TTE significantly underestimated the presence of moderate AR, compared with CMR. [32] Overall, there was only fair agreement between CMR and TTE regarding the grading of AR (weighted κ = 0.33). The investigators indicated given that higher AR severity on echocardiography has been associated with worse patient outcome, prospective studies of the potential incremental prognostic value of CMR are warranted in this setting. [32]

In a separate study, Harris et al noted that CMR-derived regurgitant volume was more predictive of clinical outcomes than that derived by TTE in patients with AR, whereas both imaging modalities demonstrated similar performances for patients with mitral regurgitation. [33] Regurgitant volume greater than 50 mL on CMR identified those with AR at high risk, with 50% undergoing valve surgery, compared to 0% in those whose regurgitant volumes were 50 mL or less.

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