Imaging Modality Advantages Disadvantages Additional Information
2D TTE Affordable, widely accessible, assesses valvular apparatus and RV strain analysis. Limited by poor acoustic windows and lower spatial resolution. Identifies tricuspid regurgitation through a “dagger-shaped” profile.
3D TTE Enhances visualisation of valve leaflets and subvalvular apparatus, aids in operative planning. Shares similar limitations with 2D TTE regarding acoustic windows. Allows simultaneous assessment of all valve leaflets.
TOE Improved visualisation of the pulmonic valve and valves with suboptimal windows. Image quality may be compromised by poor acoustic windows. Recommended for comprehensive valvular assessment when transthoracic imaging is inconclusive.
Cardiac CT Facilitates operative planning, visualises coronary arteries, assesses RV dimensions and valvular damage. Exposure to radiation and contrast. Useful postoperatively for assessing pulmonic prosthetic valve thrombosis.
Cardiac MRI Improved visualisation of valves, accurate measurement of regurgitant volumes and chamber sizes, identification of myocardial metastasis. Higher cost and contrast exposure compared to echocardiography. Emerging as a prominent modality for CaHD identification.
ECG Can indicate sinus tachycardia and nonspecific ST and T-wave changes. Not specific for CaHD; findings are generally non-specific. Reduction in QRS voltage is a less frequent finding.
CXR Can show right heart chamber prominence and pleural effusions in severe right-sided valve disease. Non specific; metastatic pleural plaques may be identified late in the disease course. Offers a non-invasive initial assessment tool.
PET Highly sensitive and specific for myocardial metastasis detection. High cost and limited availability. Utilises radioactively-labelled somatostatin analogs for detecting neuroendocrine neoplasms.