Differentielle Bildgebung bei der Beurteilung der Mitralinsuffizienz

Differential imaging in the evaluation of mitral valve insufficiency
In current clinical practice, choosing the optimal imaging technique for the quantification and differential diagnosis of mitral valve insufficiency constitutes a challenge, even for well-experienced cardiologists. This review article sought to identify the best possible method, or at least outline the most appropriate alternatives, depending on the context under discussion.
Echocardiography, and particularly color Doppler imaging, still constitutes the method of choice for quantifying mitral valve insufficiency. While the major advantage of 3–dimensional (3D) echocardiography consists in its ability to accurately capture the often complex geometrical relationships involved, 2-dimensional (2D) echocardiography achieves higher temporal and spatial resolution. 2D echocardiography is the basic technique to evaluate cases of organic or functional mitral valve insufficiency. 3D transesophageal echocardiography (TEE) plays a significant role specifically in the peri-interventional or peri-operative setting.
Cardiac magnetic resonance imaging (MRI) is an excellent technique for characterizing anatomical relationships, and represents the gold standard for assessing ventricular and atrial volumes. In addition, as it allows for blood flow to be directly quantified, cardiac MRI is considered the preferred alternative to echocardiography for the evaluation of mitral valve insufficiency. MRI is still, however, used to a limited extent in current clinical practice, owing to its relatively high cost and restricted availability.
Computed tomography (CT) enables us to quantify both valvular regurgitation area and regurgitant volume. Due to the exposure to ionizing radiation and lack of blood flow quantification associated with this technique, its use in clinical practice is recommended only in exceptional cases, particularly for the combined assessment of coronary stenoses and mitral insufficiency. In the event of severe annular calcifications, CT can be used to both quantify the extent of valve calcification and identify the underlying pathology.