[Dynamic magnetic resonance tomography in aortic valve insufficiency: methodologic comparison with aortography and...

To evaluate the usefulness of cine-MRI for the quantitative assessment of aortic valve regurgitation, 31 patients (54 +/- 15 years of age; 22 M, 9 F) and 10 normal volunteers underwent a multi-modality imaging protocol comparing cine-MRI with color Doppler echocardiography and contrast aortography. Twenty-one patients had aortic regurgitation with an associated transvalvular gradient, 10 patients had pure valve incompetence. Aortic insufficiency as assessed by the signal void from regurgitant flow on cine-MRI was best analyzed on transversal tomograms. Both the volume of the signal void caused by turbulence above a threshold velocity, and the ratio of the diameters of the regurgitant jet and the outflow tract (dAL-Jet/DLVOT) were found to correlate closely with the (Seller's) angiographic regurgitant score by r = 0.86 each (p < 0.001), and the color Doppler echocardiographic index by r = 0.74 and 0.89, respectively (p < 0.001). Cine-MRI failed to differentiate the angiographic grades I and II, however, clearly separated grades II, III, and IV in contrast to other non-invasive imaging modalities. Moreover, a semiquantitative index derived from cine-MRI allowed a rapid assessment of the severity of regurgitation, similar to color Doppler echocardiography and the semiquantitative angiographic Seller's score. Thus, cine-MRI volumetric evaluation of transvalvular flow turbulences provides a useful and reproducible means to quantify aortic regurgitation. It also allows serial atraumatic investigations as a diagnostic alternative to color Doppler examination in patients less suitable for echocardiographic evaluation and may prove helpful in monitoring the natural course of aortic valve disease.