Which modality is used to identify bicuspid or unicuspid cusp morphology on imaging?

Which modality is used to identify bicuspid or unicuspid cusp morphology on imaging?

• A. 2D echocardiography
• B. M-mode
• C. CT angiography
• D. Color Doppler

Answer: (A)

Direct visualization of the valve leaflets is how you determine cusp number, and 2D echocardiography is best for this. Using the parasternal short-axis view at the aortic valve level, you can see how many cusps open and close. A normal valve shows three leaflets in a three‑cusp opening pattern. If two cusps are present, one cusp is fused, producing a two‑leaflet opening (often with a characteristic asymmetric or elongated appearance and sometimes a visible raphe). If a single cusp is present, the orifice appears unicuspid, with an abnormal, often pinhole-like opening. M-mode follows structures along a single line and cannot resolve the leaflet morphology, so it isn’t reliable for identifying cusp number. Color Doppler illustrates flow patterns and valve function but not the actual leaflet anatomy. CT angiography can reveal cusp morphology with high detail, but in routine imaging and for dynamic assessment of the valve itself, 2D echocardiography is the primary modality used to identify bicuspid or unicuspid morphology.

Direct visualization of the valve leaflets is how you determine cusp number, and 2D echocardiography is best for this. Using the parasternal short-axis view at the aortic valve level, you can see how many cusps open and close. A normal valve shows three leaflets in a three‑cusp opening pattern. If two cusps are present, one cusp is fused, producing a two‑leaflet opening (often with a characteristic asymmetric or elongated appearance and sometimes a visible raphe). If a single cusp is present, the orifice appears unicuspid, with an abnormal, often pinhole-like opening.

M-mode follows structures along a single line and cannot resolve the leaflet morphology, so it isn’t reliable for identifying cusp number. Color Doppler illustrates flow patterns and valve function but not the actual leaflet anatomy. CT angiography can reveal cusp morphology with high detail, but in routine imaging and for dynamic assessment of the valve itself, 2D echocardiography is the primary modality used to identify bicuspid or unicuspid morphology.