Combined Coronary CT Angiography and Evaluation of Access Vessels for TAVR Patients in Free-Breathing with Single Contrast Medium Injection Using a 16-cm-Wide Detector CT

Tao, Shuai; Li, Wanjiang; You, Yongchun; Deng, Liping; Li, Jianying; Peng, Liqing; Li, Zhenlin

doi:10.1016/j.acra.2020.08.003

Cited by 6 publications

(12 citation statements)

References 33 publications

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“…In the period between those meta-analyses and our study, seven more papers using these technologies were published [18,[20][21][22][23][24]29]. Therefore, we planned a sub-group analysis to explore the benefits of high intrinsic TR obtained by dual- source CT scanner, whole-heart coverage CT scanner, and single-heartbeat CT scanner.…”

Section: Discussionmentioning

confidence: 99%

“…A sensitivity analysis including only five studies [23,[26][27][28][29] without high or unclear risk of bias or concerns regarding applicability showed similar results to the analysis containing all studies: a total of 1003 patients were included, the pooled sensitivity and specificity for CCTA were 96% (92 -98%) and 79% (59 -91%) respectively, and the + LR and −LR were 4.6 (2.2 -9.7) and 0.05 (0.03 -0.09), with a DOR of 94 (39-227). The HSROC had AUC = 0.97 (0.95 -0.98).…”

Section: Sub-analysis: Sensitivity and Subgroup Analysismentioning

confidence: 99%

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Diagnostic accuracy of coronary computed tomography angiography for the evaluation of obstructive coronary artery disease in patients referred for transcatheter aortic valve implantation: a systematic review and meta-analysis

et al. 2022

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Objective To evaluate the diagnostic accuracy of coronary computed tomography angiography (CCTA) for the evaluation of obstructive coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI). Methods EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting accuracy of CCTA for the evaluation of obstructive CAD compared with invasive coronary angiography (ICA) as the reference standard. QUADAS-2 tool was used to assess the risk of bias. A bivariate random effects model was used to analyze, pool, and plot the diagnostic performance measurements across studies. Pooled sensitivity, specificity, positive ( + LR) and negative (−LR) likelihood ratio, diagnostic odds ratio (DOR), and hierarchical summary ROC curve (HSROC) were evaluated. Prospero registration number: CRD42021252527. Results Fourteen studies (2533 patients) were included. In the intention-to-diagnose patient-level analysis, sensitivity and specificity for CCTA were 97% (95% CI: 94–98%) and 68% (95% CI: 56–68%), respectively, and + LR and −LR were 3.0 (95% CI: 2.1–4.3) and 0.05 (95% CI: 0.03 – 0.09), with DOR equal to 60 (95% CI: 30–121). The area under the HSROC curve was 0.96 (95% CI: 0.94–0.98). No significant difference in sensitivity was found between single-heartbeat and other CT scanners (96% (95% CI: 90 – 99%) vs. 97% (95% CI: 94–98%) respectively; p = 0.37), whereas the specificity of single-heartbeat scanners was higher (82% (95% CI: 66–92%) vs. 60% (95% CI: 46 – 72%) respectively; p < 0.0001). Routine CCTA in the pre-TAVI workup could save 41% (95% CI: 34 – 47%) of ICAs if a disease prevalence of 40% is assumed. Conclusions CCTA proved an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI; the use of single-heartbeat CT scanners can further improve these findings. Key Points • CCTA proved to have an excellent diagnostic accuracy for assessing obstructive CAD in patients referred for TAVI. • Routine CCTA in the pre-TAVI workup could save more than 40% of ICAs. • Single-heartbeat CT scanners had higher specificity than others in the assessment of obstructive CAD in patients referred for TAVI.

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Section: Discussionmentioning

confidence: 99%

Section: Sub-analysis: Sensitivity and Subgroup Analysismentioning

confidence: 99%

Diagnostic accuracy of coronary computed tomography angiography for the evaluation of obstructive coronary artery disease in patients referred for transcatheter aortic valve implantation: a systematic review and meta-analysis

et al. 2022

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“…The utilization of CTA for coronary artery assessment in patients scheduled for TAVI has been investigated previously [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. An overview of available study experience in the context of combined coronary CTA and TAVI evaluation is provided in Table 1 .…”

Section: Overview Of the Current Literaturementioning

confidence: 99%

“…At the same time, these CT system requirements are crucial for coronary artery image acquisition. The feasibility of coronary artery assessment with CTA in a subset of patients scheduled for TAVI has been established previously and based on further development in the field of CT technology, with improved spatial and temporal resolution, its potential value has been suggested [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Only recently, the addition of computational fluid dynamic-based and machine learning (ML)-based solutions for fractional flow reserve from CTA (CT–FFR) showed the potential to improve the diagnostic performance of CTA before TAVI [ 24 , 25 , 26 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Combined CT Coronary Artery Assessment and TAVI Planning

2023

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Computed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-making. In addition to providing relevant diagnostic information on the degree of aortic valve calcification, CTA allows for a customized choice of the transcatheter heart valve system and the TAVI access route. Furthermore, current guidelines recommend the exclusion of relevant coronary artery disease (CAD) prior to TAVI. The feasibility of coronary artery assessment with CTA in patients scheduled for TAVI has been established previously, and accumulating data support its value. In addition, fractional flow reserve determined from CTA (CT–FFR) and machine learning-based CT–FFR were recently shown to improve its diagnostic yield for this purpose. However, the utilization of CTA for coronary artery evaluation remains limited in this specific population of patients due to the relatively high risk of CAD coexistence with severe AS. Therefore, the current diagnostic work-up prior to TAVI routinely includes invasive catheter coronary angiography at most centers. In this article, the authors address technological prerequisites and CT protocol considerations, discuss pitfalls, review the current literature regarding combined CTA coronary artery assessment and preprocedural TAVI evaluation, and provide an overview of unanswered questions and future research goals within the field.

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“…Therefore, various post-processing techniques (motion artifact correction, MAC) have been developed and commercialized to correct distorted blood vessels due to involuntary respiratory movements [5][6][7][8][9][10][11]. Additionally, as CBCT equipped with MAC technique has become widely available, several studies evaluating their performance have been published [8][9][10][12][13][14][15][16]. Image distortion due to respiratory motion was corrected using the patient-specific respiratory motion model, and the displacement by motion was measured to evaluate the MAC [9].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Motion Artifact Correction Technique for Cone-Beam Computed Tomography Image Considering Blood Vessel Geometry

Jung,

Lee,

Jun

et al. 2024

JCM

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Background: In this study, we present a quantitative method to evaluate the motion artifact correction (MAC) technique through the morphological analysis of blood vessels in the images before and after MAC. Methods: Cone-beam computed tomography (CBCT) scans of 37 patients who underwent transcatheter chemoembolization were obtained, and images were reconstructed with and without the MAC technique. First, two interventional radiologists selected the blood vessels corrected by MAC. We devised a motion-corrected index (MCI) metric that analyzed the morphology of blood vessels in 3D space using information on the centerline of blood vessels, and the blood vessels selected by the interventional radiologists were quantitatively evaluated using MCI. In addition, these blood vessels were qualitatively evaluated by two interventional radiologists. To validate the effectiveness of the devised MCI, we compared the MCI values in a blood vessel corrected by MAC and one non-corrected by MAC. Results: The visual evaluation revealed that motion correction was found in the images of 23 of 37 patients (62.2%), and a performance evaluation of MAC was performed with 54 blood vessels in 23 patients. The visual grading analysis score was 1.56 ± 0.57 (radiologist 1) and 1.56 ± 0.63 (radiologist 2), and the proposed MCI was 0.67 ± 0.11, indicating that the vascular morphology was well corrected by the MAC. Conclusions: We verified that our proposed method is useful for evaluating the MAC technique of CBCT, and the MAC technique can correct the blood vessels distorted by the patient’s movement and respiration.

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Combined Coronary CT Angiography and Evaluation of Access Vessels for TAVR Patients in Free-Breathing with Single Contrast Medium Injection Using a 16-cm-Wide Detector CT

Cited by 6 publications

References 33 publications

Diagnostic accuracy of coronary computed tomography angiography for the evaluation of obstructive coronary artery disease in patients referred for transcatheter aortic valve implantation: a systematic review and meta-analysis

Diagnostic accuracy of coronary computed tomography angiography for the evaluation of obstructive coronary artery disease in patients referred for transcatheter aortic valve implantation: a systematic review and meta-analysis

Combined CT Coronary Artery Assessment and TAVI Planning

Evaluation of Motion Artifact Correction Technique for Cone-Beam Computed Tomography Image Considering Blood Vessel Geometry

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