Benefits of photon counting CT for the assessment of native heart valves

Systematic data about whether photon counting detector CT (PCD-CT) could improve the assessment of native heart valves is lacking. Thus, the aim of this study was to assess the performances of PCD-CT for the evaluation of native heart valves as compared to energy integrating detector CT (EID-CT).

Patients necessitating coronary artery CT were prospectively included (February 2021 to December 2022) to undergo an ECG-gated PCD-CT and EID-CT. A subjective assessment of the sharpness and conspicuity of each of the components of the four valves was performed with a 4-point scale. The number of small structures of the valvular apparati was calculated. The number of calcifications per leaflet and their localization within the thickness of the aortic leaflets were noted. The volume of the calcifications and the full width at mid weight (FWMH) of the aortic valve were calculated.

Thirty-three patients (62 ± 13 years; 88 % men) were included. Conspicuity of aortic, mitral, and pulmonary valvular structures was increased with PCD-CT (all < 0.05) except for the aortic right-non-coronary commissure and the pulmonary right-left commissure (p = 0.06 and p = 0.07). Sharpness was superior for all the borders and the commissures of the aortic and mitral valve (all p < 0.05). More fine structures (nodules, chordae) and calcifications were visible with PCD-CT. The precise localization of the calcifications could be assessed with PCD-CT in most cases (70 %) while the volumes were similar (p = 0.07). FWMH was lower with PCD-CT (1.7(IQ = 1.1) vs 2.5 mm (IQ = 1.3); p < 0.01).

PCD-CT yielded better subjective and objective image quality of native aortic, mitral and pulmonary valves and allowed for more structures to be detected compared to EID-CT. This might result in earlier, improved diagnosis of valve pathologies.