Review Article Computed tomography assessment of valvular morphology, function, and disease Joseph Jen-Sho Chen, MD * , Jean Jeudy, MD, Eric M. Thorn, MD, Charles S. White, MD University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD 21201, USA KEYWORDS: Aortic valve; Computed tomography (CT); Computed tomography angiography (CTA); Insufficiency; Mitral valve; Pulmonic valve; Stenosis; Tricuspid valve; Valvular heart disease Abstract. Recent advancement in computed tomography angiography (CTA) has enabled the noninva- sive delineation of cardiac valves using this method. Although echocardiography is the current stan- dard, CTA is a valuable complementary imaging method to evaluate valvular morphology and function. In addition, CTA may contribute to the assessment of both congenital and acquired valvular heart disease, infectious endocarditis, and postsurgical complications of valve replacement. Ó 2009 Society of Cardiovascular Computed Tomography. All rights reserved. Introduction Echocardiography is the current reference standard imag- ing technique in the assessment of cardiac valves. 1 Echocar- diography is accurate, noninvasive, widely accessible, portable, and, in most cases, provides sufficient information for therapeutic planning. However, echocardiography has several limitations, including operator dependence and poor acoustic windows in patients with emphysema or a large body habitus. Magnetic resonance (MR) imaging has proved valuable and, like echocardiography, does not expose the patient to ionizing radiation. Although it may be difficult to perform in patients with claustrophobia or contraindicated in patients with internal cardiac defibrillators, pacemakers, insulin pumps, or spinal cord stimulators. Recent technical advances in electrocardiogram (ECG)– gating computed tomography angiography (CTA) now allows noninvasive assessment of coronary arteries and detection of coronary artery stenoses with high sensitivity and specificity in selected patients. 2,3 Moreover, CTA permits concurrent evaluation of myocardial perfusion, global and regional left ventricular function, and valvular morphology, function, and disease. 1,4–8 The use of CTA to assess the cardiac valves is described in this article. CT acquisition and reconstruction Excellent temporal resolution is critical for assessment of cardiac valves. Sixty-four–slice CTA has a temporal resolution of approximately 83–180 msec, depending on scanner and reconstruction type. However, the temporal resolution is still lower than both MR imaging, and 2- and Conflict of interest: The authors report no conflicts of interest. * Corresponding author. E-mail address: jchen1@umm.edu Submitted June 24, 2008. Accepted for publication October 1, 2008. 1934-5925/09/$ -see front matter Ó 2009 Society of Cardiovascular Computed Tomography. All rights reserved. doi:10.1016/j.jcct.2008.10.017 Journal of Cardiovascular Computed Tomography (2009) 3, Supplement 1, S47–S56