Eur Radiol (2011) 21:1390–1396 DOI 10.1007/s00330-011-2068-8 CARDIAC Prosthetic heart valve assessment with multidetector-row CT: imaging characteristics of 91 valves in 83 patients Jesse Habets & Petr Symersky & Lex A. van Herwerden & Bas A. J. M. de Mol & Anje M. Spijkerboer & Willem P. Th. M. Mali & Ricardo P. J. Budde Received: 18 October 2010 / Revised: 26 November 2010 / Accepted: 12 December 2010 / Published online: 29 January 2011 # The Author(s) 2011. This article is published with open access at Springerlink.com Abstract Objectives Multidetector CT (MDCT) has shown potential for prosthetic heart valve (PHV) assessment. We assessed the image quality of different PHV types to determine which valves are suitable for MDCT evaluation. Methods All ECG-gated CTs performed in our institutions since 2003 were reviewed for the presence of PHVs. After reconstruction in 3 specific PHV planes, image quality of the supravalvular, perivalvular, subvalvular and valvular regions was scored on a four-point scale (1=non-diagnostic, 2= moderate, 3= good and 4=excellent) by two independent observers. Results Eighty-four CT examinations (66 cardiac, 18 limited- dose aortic protocols) of 83 patients with a total of 91 PHVs in the aortic (n =71), mitral (n=17), pulmonary (n=1) and J. Habets (*) : W. P. T. M. Mali : R. P. J. Budde Department of Radiology, UMC Utrecht, P.O. Box 85500, E01.132, 3508 GA Utrecht, The Netherlands e-mail: J.Habets@umcutrecht.nl L. A. van Herwerden Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands P. Symersky Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands A. M. Spijkerboer Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands P. Symersky : B. A. J. M. de Mol Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands tricuspid (n=2) position were included. CT was performed on a 16-slice (n=4), 64-slice (n=28) or 256-slice (n=52) MDCT system. Median image quality scores for the supra-, peri- and subvalvular regions and valvular detail were (3.5, 3.3, 3.5 and 3.5, respectively) for bileaflet PHV; (3.0, 3.0, 3.5 and 3.0, respectively) for Medtronic Hall PHV; (1.0, 1.0, 1.0 and 1.0, respectively) for Björk-Shiley and Sorin monoleaflet PHV and (3.5, 3.5, 4.0 and 2.0 respectively) for biological PHV. Conclusion Currently implanted PHVs have good image quality on MDCT and are suitable for MDCT evaluation. Keywords Prosthetic heart valve . Image quality . Heart valve . Cardiac imaging . Computed tomography Introduction Prosthetic heart valve (PHV) dysfunction is an uncommon complication after PHV implantation with potential life- threatening consequences. In daily clinical practice, (sus- pected) PHV dysfunction is evaluated by the following non-invasive imaging techniques: transthoracic echocardi- ography (TTE), transesophageal echocardiography (TEE) and fluoroscopy [1]. These imaging techniques can detect PHV dysfunction accurately. However, echocardiography and fluoroscopy may fail to detect the anatomical substrate which causes PHV dysfunction [2]. Causes of PHV dysfunc- tion include: pannus formation (subprosthetic tissue prolifer- ation), thrombus formation, patient prosthesis mismatch (PPM, a too small valve for the patient’s body size), pathologic (para)valvular leakage and endocarditis [1]. Recently, multidetector computed tomography (MDCT) has shown potential for non-invasive evaluation of PHV (dys)function. In small studies, MDCT demonstrated