Imaging

Aortic Sclerosis

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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