The Utility of Cardiac Computed Tomographic Angiography in Differentiating Between Papillary Fibroelastoma, Infective Endocarditis, and Degeneration of the Aortic Valve.

Purpose: Cardiac computed tomography angiography (CCTA) has significantly advanced the visualization of cardiac structures, particularly valves. We assessed the diagnostic performance of CCTA in diagnosing the most common disorders affecting the aortic valves requiring surgery-papillary fibroelastoma, infective endocarditis, and degeneration.

Methods: This retrospective study included patients who underwent aortic valve resection between 2016 and 2023 and had a preceding CCTA. Pathologic diagnoses were categorized into the following 3 groups: papillary fibroelastoma, infective endocarditis, and degeneration. Each case was independently evaluated by 3 cardiac-trained radiologists.

Results: The study group consisted of 50 patients with aortic valvular disorder-14 papillary fibroelastoma, 13 endocarditis, and 23 degeneration. Diagnostic accuracy varied from 70% to 74% among the 3 readers, with a pooled accuracy of 71% and consensus accuracy of 76%. Most errors involved small (≤7 mm) papillary fibroelastomas. Both papillary fibroelastomas and endocarditis-related vegetations typically presented with nodules on CT; however, nodule stalks were only observed with papillary fibroelastomas. Echocardiography aided in distinguishing between the disorders by detecting leaflet perforation and aortic regurgitation in cases of infective endocarditis.

Conclusions: This study evaluated cardiac CTA for noninvasive characterization of aortic valvular disorders prior to resection. Reader accuracy ranged from 70% to 74%, improving to 76% with consensus interpretations. Small papillary fibroelastomas (≤7 mm) and overlapping imaging features, such as nodular lesions and leaflet thickening, were diagnostic challenges. Greater awareness of these CT characteristics is essential for accurate diagnosis and clinical management.