Which imaging modality is preferred to evaluate suspected valvular disease such as aortic stenosis?

• A. Angiography
• B. CT scan
• C. MRI
• D. Echocardiography

Answer: (D)

Echocardiography is the imaging test of choice for suspected valvular disease because it combines direct visualization of valve anatomy with real-time measurement of blood flow and pressure across the valve. This allows you to confirm the valve abnormality (eg, stenosis from leaflet restriction or calcification) and quantify severity using Doppler-derived gradients, velocity, and estimated valve area, while also assessing how the left ventricle is coping with the valve lesion. Transthoracic echocardiography is noninvasive, widely available, and radiation-free, making it ideal as the initial study. If image quality is limited or detailed anatomy is needed for planning, transesophageal echocardiography provides higher-resolution images. Other modalities have important roles—CT can gauge valve calcification and anatomy for procedures, MRI can quantify flow and regurgitation precisely, and angiography is invasive and mainly used for coronary assessment or intervention—not as the first-line tool for evaluating valvular disease.