Fig. 16

Quantitative volumetric assessment of the native aortic valve apparatus calcification burden based on pre-TAVR ECG-gated cardiac MDCT. This technique requires creation of a series of 3-mm-thick contiguous double-oblique CT images in the short-axis plane of the native aortic valve apparatus that will include the whole volume of the TAVR device landing zone, defined as the area of the aortic valve annulus, valvular cusps and LVOT (up to the junction point of the anterior mitral leaflet) (a). At each reformatted image using the planimetry technique, regions of interest (ROI) are drawn around all perceived areas of calcification (b). Note that the mean density of all drawn ROIs is significantly higher by more than 2 SD than the mean blood pool density as measured in (a), indicating true calcifications. These regions of interest at all levels are added together and multiplied by the slice thickness (3 mm) to derive a quantitative total volumetric calcium score in mm³ representing the calcification burden of the entire native aortic valve apparatus