Imaging
Aortic Sclerosis
- Preliminary Diagnosis: Aortic Sclerosis
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of Aortic Stenosis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Aortic Sclerosis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Aortic Sclerosis
I. What imaging technique is first-line for this diagnosis
Gray scale and color doppler echocardiography (transesophageal offers better resolution compared to transthoracic)
II. Describe the advantages and disadvantages of this technique for diagnosis of Aortic Stenosis.
Advantages
Highly portable, fast, and relatively inexpensive imaging modality.
Does not expose patients to ionizing radiation.
Disadvantages
Highly operator dependent.
Offers exquisite visualization of turbulent flow across the valve and details high pressure gradients seen in patients with aortic stenosis/sclerosis.
Cannot be used for intervention.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to echocardiography exist.
IV. What alternative imaging techniques are available?
Cardiac CTA
Cardiac MR
Conventional Cardiac Angiography.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Aortic Sclerosis.
Cardiac CTA
Advantages
Offers more exquisite detail of the surrounding soft tissues, osseous structures, and soft tissues.
More sensitive and specific in evaluating for calcification and thickening of the leaflets than echocardiography
Disadvantages
Does not offer dynamic imaging capability.
Exposes patients to ionizing radiation.
Cardiac MR
Advantages
Does not expose patients to ionizing radiation.
Disadvantages
Must be cardiac gated and may be subject to motion artifact and flow artifact from inadequate gaiting.
May not be performed in patients with non MR compatible hardware.
Conventional Cardiac Angiography
Advantages
Useful in diagnosis and treatment in patients with aortic stenosis.
Offers exquisite dynamic imaging capabililty and delivers highly specific information on valvular flow.
Disadvantages
Less exquisite in detailing the anatomy of the surrounding soft tissues, vascular structures, and osseous structures,
Exposes patients to large amounts of ionizing radiation.
Highly invasive and is associated with more morbidity and mortality compared to companion non invasive imaging techniques.
VI. What are the contraindications for the alternative imaging techniques?
Cardiac CTA
May not be performed in pregnant patients.
Cardiac MR
Contraindicated in patients with non MR compatible hardware.
Conventional Cardiac Angiography
Contraindicated in patients who are in a severe hypocoaguable state.
Non iodine based contrast agents such as CO2 may have to be used in patients with a contrast allergy.
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