Quantification of aortic valve stenosis in MRI - Comparison of steady-state free precession and fast low-angle shot sequences

We compared two different magnetic resonance (MR) sequences [steady-state free precession (SSFP) and gradient echo fast low-angle shot (FLASH)] for the assessment of aortic valve areas in aortic stenosis using transesophageal echocardiography (TEE) as the standard of reference. Thirty-two patients with known aortic stenosis underwent MR (1.5 T) using a cine SSFP sequence and a cine FLASH sequence. Planimetry was performed in cross-sectional images and compared to the results of the TEE. In seven patients the grade of stenosis was additionally assessed by invasive cardiac catheterization (ICC). The mean aortic valve area measured by TEE was 0.97±0.19 mm², 1.00±0.25 mm² for SSFP and 1.25±0.23 mm² based on FLASH images. The mean difference between the valve areas assessed based on SSFP and TEE images was 0.15±0.13 cm² (FLASH vs TEE: 0.29±0.17 cm²). Bland-Altman analysis demonstrated that measurements using FLASH images overestimated the aortic valve area compared to TEE. Comparing ICC with MRI and TEE, only a weak to moderate correlation was found (ICC vs TEE: R=0.52, p=0.22; ICC vs SSFP: R=0.20, p=0.65; ICC vs FLASH: R=0.16, p=0.70). Measurements of the aortic valve area based on SSFP images correlate better with TEE compared to FLASH images.