Journal Article

Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning

De Cecco, Carlo N., Varga-Szemes, Akos, Wichmann, Julian L., Litwin, Sheldon E., Schoepf, U. Joseph, Mangold, Stefanie, Felmly, Lloyd M., Vogl, Thomas J., McQuiston, Andrew D., Bayer, Richard R.

2017

Overview

Purpose To investigate feasibility, image quality and safety of low-tube-voltage, low-contrast-volume comprehensive cardiac and aortoiliac CT angiography (CTA) for planning transcatheter aortic valve replacement (TAVR). Materials and methods Forty consecutive TAVR candidates prospectively underwent combined CTA of the aortic root and vascular access route (270 mgI/ml iodixanol). Patients were assigned to group A (second-generation dual-source CT [DSCT], 100 kV, 60 ml contrast, 4.0 ml/s flow rate) or group B (third-generation DSCT, 70 kV, 40 ml contrast, 2.5 ml/s flow rate). Vascular attenuation, noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were compared. Subjective image quality was assessed by two observers. Estimated glomerular filtration (eGFR) at CTA and follow-up were measured. Results Besides a higher body-mass-index in group B (24.8±3.8 kg/m 2 vs. 28.1±5.4 kg/m 2 , P =0.0339), patient characteristics between groups were similar ( P ≥0.0922). Aortoiliac SNR ( P =0.0003) was higher in group B. Cardiac SNR ( P =0.0003) and CNR ( P =0.0181) were higher in group A. Subjective image quality was similar ( P ≥0.213) except for aortoiliac image noise (4.42 vs. 4.12, P =0.0374). TAVR-planning measurements were successfully obtained in all patients. There were no significant changes in eGFR among and between groups during follow-up ( P ≥0.302). Conclusion TAVR candidates can be safely and effectively evaluated by a comprehensive CTA protocol with low contrast volume using low-tube-voltage acquisition. Key Points • Third - generation dual - source CT facilitates low - tube - voltage acquisition . • TAVR planning can be performed with reduced contrast volume and radiation dose . • TAVR - planning CT did not result in changes in creatinine levels at follow - up . • TAVR candidates can be safely evaluated by comprehensive low - tube - voltage CT angiography .

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Aged / Aged, 80 and over / Aortic stenosis / Aortic Valve - surgery / Aortic Valve Stenosis - diagnostic imaging / Aortic Valve Stenosis - surgery / Cardiac / Computed Tomography Angiography - methods / Cone-Beam Computed Tomography - methods / Contrast agents / Contrast Media / Coronary vessels / Diagnostic Radiology / Feasibility Studies / Female / Humans / Imaging / Internal Medicine / Interventional Radiology / Iodine / Male / Medical imaging / Medicine / Medicine & Public Health / Neuroradiology / Patient Care Planning / Patients / Prostheses / Radiation / Radiation Dosage / Radiology / Retrospective Studies / Tomography / Transcatheter Aortic Valve Replacement - methods / Triiodobenzoic Acids / Ultrasound