Armando Ugo Cavallo1, Andrew J Patterson2, Rahul Thomas2, Mohamad Amer Alaiti2, Guilherme F Attizzani2, Kai Laukamp3, Nils Große Hokamp4, Hiram Bezerra2, Robert Gilkeson2, Sanjay Rajagopalan5. 1. University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine and Radiology, Case Western Reserve University, Cleveland, OH, USA; Division of Radiology, University Hospital Policlinico "Tor Vergata", Rome, Italy. 2. University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine and Radiology, Case Western Reserve University, Cleveland, OH, USA. 3. University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine and Radiology, Case Western Reserve University, Cleveland, OH, USA; Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany. 4. Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany. 5. University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine and Radiology, Case Western Reserve University, Cleveland, OH, USA. Electronic address: sanjay.rajagopalan@uhhospitals.org.
Abstract
BACKGROUND: Computed tomographic angiography (CTA) based planning for transcatheter aortic valve replacement (TAVR) is essential for reduction of periprocedural complications. Spectral CT based imaging provides several advantages, including better contrast/signal to noise ratio and increased soft tissue contrast, permitting better delineation of contrast filled structures at lower doses of iodinated contrast media. The aim of this prospective study was to assess the initial feasibility of a low dose iodinated contrast protocol, utilizing monoenergetic 40 keV reconstruction, using a dual-layer CT scanner (DLCT) for CTA in patients undergoing TAVR planning. METHODS: 116 consecutive TAVR patients underwent a gated chest and a non-gated CTA of the abdomen and pelvis. 40 keV virtual monoenergetic images (VMI) were reconstructed and compared with conventional polychromatic images (CI). The proximal aorta and access vessels were scored for image quality by independent experienced cardiovascular imagers. RESULTS: Proximal aortic image quality as assessed by signal to noise (SNR) and contrast to noise ratio (CNR), were significantly better with 40 keV VMI relative to CI (SNR 14.65 ± 7.37 vs 44.16 ± 22.39, p < 0.001; CNR 15.84 ± 9.93 vs 59.8 ± 40.83, p < 0.001). Aortic root dimensions were comparable between the two approaches with a bias towards higher measurements at 40 keV (Bland Altman). SNR and CNR in all access vessel segments at 40 keV were substantially better (p < 0.001 for all peripheral access vessel segments) with comparable image quality. CONCLUSION: 40 keV VMI with low dose contrast dose spectral imaging is feasible for comprehensive preprocedural evaluation of access vessels and measurements of aortic root dimensions in patients undergoing TAVR.
BACKGROUND: Computed tomographic angiography (CTA) based planning for transcatheter aortic valve replacement (TAVR) is essential for reduction of periprocedural complications. Spectral CT based imaging provides several advantages, including better contrast/signal to noise ratio and increased soft tissue contrast, permitting better delineation of contrast filled structures at lower doses of iodinated contrast media. The aim of this prospective study was to assess the initial feasibility of a low dose iodinated contrast protocol, utilizing monoenergetic 40 keV reconstruction, using a dual-layer CT scanner (DLCT) for CTA in patients undergoing TAVR planning. METHODS: 116 consecutive TAVR patients underwent a gated chest and a non-gated CTA of the abdomen and pelvis. 40 keV virtual monoenergetic images (VMI) were reconstructed and compared with conventional polychromatic images (CI). The proximal aorta and access vessels were scored for image quality by independent experienced cardiovascular imagers. RESULTS: Proximal aortic image quality as assessed by signal to noise (SNR) and contrast to noise ratio (CNR), were significantly better with 40 keV VMI relative to CI (SNR 14.65 ± 7.37 vs 44.16 ± 22.39, p < 0.001; CNR 15.84 ± 9.93 vs 59.8 ± 40.83, p < 0.001). Aortic root dimensions were comparable between the two approaches with a bias towards higher measurements at 40 keV (Bland Altman). SNR and CNR in all access vessel segments at 40 keV were substantially better (p < 0.001 for all peripheral access vessel segments) with comparable image quality. CONCLUSION: 40 keV VMI with low dose contrast dose spectral imaging is feasible for comprehensive preprocedural evaluation of access vessels and measurements of aortic root dimensions in patients undergoing TAVR.
Authors: Todd C Villines; Subhi J Al'Aref; Daniele Andreini; Marcus Y Chen; Andrew D Choi; Carlo N De Cecco; Damini Dey; James P Earls; Maros Ferencik; Heidi Gransar; Harvey Hecht; Jonathon A Leipsic; Michael T Lu; Mohamed Marwan; Pál Maurovich-Horvat; Edward Nicol; Gianluca Pontone; Jonathan Weir-McCall; Seamus P Whelton; Michelle C Williams; Armin Arbab-Zadeh; Gudrun M Feuchtner Journal: J Cardiovasc Comput Tomogr Date: 2021-02-22
Authors: Serena Dell'Aversana; Raffaele Ascione; Marco De Giorgi; Davide Raffaele De Lucia; Renato Cuocolo; Marco Boccalatte; Gerolamo Sibilio; Giovanni Napolitano; Giuseppe Muscogiuri; Sandro Sironi; Giuseppe Di Costanzo; Enrico Cavaglià; Massimo Imbriaco; Andrea Ponsiglione Journal: J Imaging Date: 2022-09-01
Authors: David C Rotzinger; Damien Racine; Fabio Becce; Elias Lahoud; Klaus Erhard; Salim A Si-Mohamed; Joël Greffier; Anaïs Viry; Loïc Boussel; Reto A Meuli; Yoad Yagil; Pascal Monnin; Philippe C Douek Journal: Diagnostics (Basel) Date: 2021-12-16