Could Photon-Counting CT Supplant Echocardiography for Primary Imaging of Transcatheter Heart Valves?

For years, transcatheter heart valves have been assessed mainly by echocardiography with CT playing an important but often “structural” supporting role.

That paradigm is changing.

Photon-counting CT (PCCT) is not simply another incremental improvement in image quality. It is enabling a new level of morpho-functional characterization of transcatheter valves.

We can now visualize details that were previously blurred by blooming, noise, or limited spatial resolution. These details include:

• leaflet morphology with unprecedented definition;
• subtle leaflet thickening;
• hypoattenuated leaflet abnormalities (HALT);
• reduced leaflet motion;
• commissural configuration;
• frame expansion and deformation; and
• interaction with the native annulus and surrounding structures.

Perhaps even more importantly, high-resolution temporal and spatial imaging allows us to start connecting anatomy with function.

Why is one valve performing differently from another?Why do two apparently identical prostheses generate different gradients? How much of valve dysfunction is explained by geometry rather than biology?

These are no longer purely echocardiographic questions.

Photon-counting CT is evolving from a technology that “shows beautiful pictures” into one that explains why prosthetic valves behave the way they do. Morphology and function are finally being interpreted together rather than separately.

The future of structural heart imaging will not be defined by choosing between CT and echocardiography. It will be defined by integrating complementary information with PCCT providing anatomical insights that were previously inaccessible.

Seeing more is not the goal. Understanding more is.

Dr. Cademartiri is the director of advanced cardiovascular imaging and photon-counting CT at the Scientific Institute for Research, Hospitalization, and Healthcare Synlab Diagnostic Network in Naples, Italy. He is also a consultant in advanced cardiovascular imaging at CDI/Centro Diagnostico Italiano in Milan, Italy.

(Editor’s note: This blog is adapted with permission from Dr. Cademartiri’s original LinkedIn post at:

https://www.linkedin.com/feed/update/urn:li:activity:7492579057860034560/ .