This paper describes “how to” examine cardiac valves with computed tomography, the normal, diseased valves, and prosthetic valves. A review of current scientific literature is provided. Firstly, technical basics, “how to” perform and optimize a multislice CT scan and “how to” interpret valves on CT images are outlined. Then, diagnostic imaging of the entire spectrum of specific valvular disease by CT, including prosthetic heart valves, is highlighted. The last part gives a guide “how to” use CT for planning of transcatheter aortic valve implantation (TAVI), an emerging effective treatment option for patients with severe aortic stenosis. A special focus is placed on clinical applications of cardiac CT in the context of valvular disease. 1. Introduction Multislice computed tomography (CT) is a new modality for noninvasive evaluation of cardiac valves, with new clinical applications arising over the past years. While multislice CT has been established for assessment of coronary arteries for a decade, the cardiac valves were neglected initially. One reason was the fact that echocardiography is a strong modality in clinical practice. Still, it has its own limitations, such as being related to observer variability and high individual differences in image quality pending on body habitus, or its flow dependency. Further, echocardiography has limitations in assessing valvular morphology. Therefore, multimodality imaging, including CT is required, for diagnostic workup of valvular disease. The first part of this paper describes technical basics of CT, how to perform and optimize a multislie CT scan. Then, “how to’’ interpret valves on CT and how to diagnose the specific valvular disease, including prosthetic valve dysfunction, are illustrated. Finally, a guide “how to’’ utilize CT in patients with severe aortic stenosis scheduled for planning of transcatheter aortic valve implantation (TAVI) is provided. TAVI is an emerging treatment option in those populations. Current scientific evidence and literature are reviewed. A special focus is placed on the most recent and useful clinical applications in terms of “when and why’’ we use cardiac CT in the context of valvular disease effectively in practice. 2. Technical Basics From Dream to Reality. While in early 2000, 4D-cine imaging (“cine imaging”) of cardiac function by multislice computed tomography (CT) was a “dream not yet true”, continunous advances in mainly temporal, but also spatial resolution, have created new horizons. Since 2005, with 16, 64, or more slices and increasing gantry rotation speed, both spatial
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