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. 2020 May 3;11(3):155–167. doi: 10.14740/cr1011

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Copyright 2020, Sharma et al.

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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(a) The aortic valve complex used for analysis is created using a batching tool to separate the study images from the larger, original. The batching tool is visible in the bottom left in the axial view as a box of green lines, and it is centered at the annular plane (red axes). It extends 5 mm caudally from the annular plane and cranially to the tip of the upper leaflets. Each green line represents 1 mm. The output at the level of the annular plane is in the top-right box, with the cusps labeled as right coronary cusp (RCC), left coronary cusp (LCC) and non-coronary cusp (NCC) for orientation. (b) Tool used to calculate mean attenuation in Hounsfield Units (HU) to adjust cutoffs for calcium scoring. In this image, the mean luminal attenuation is 456 HU, so a cutoff of 550 HU was used. (c) Zoomed in view of leaflet calcification in one slice of the upper leaflet zone for each leaflet. (d) Calcification of each leaflet in this slice in the upper leaflet zone was traced using calcium analysis software, which then provided a calcium score, volume and mean. In the device landing zone and annulus region, a total calcium score, volume and mean was provided.