Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior to transcatheter aortic valve implantation

Bittner, Daniel O.; Arnold, Martin; Klinghammer, Lutz; Schuhbaeck, Annika; Hell, Michaela M.; Muschiol, Gerd; Gauss, Soeren; Lell, Michael; Uder, Michael; Hoffmann, Udo; Achenbach, Stephan; Marwan, Mohamed

doi:10.1007/s00330-016-4320-8

Cited by 49 publications

(33 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A pre-procedural CTA allows for annulus sizing, device selection, evaluation of suitability of the peripheral arteries for access, as well as selection of appropriate fluoroscopic projections and is considered vital for procedural success of TAVR (19). Candidates for TAVR often have co-morbidities such as chronic renal failure that can adversely impact outcomes (20)(21)(22). There has been ongoing debate about the actual incidence, significance and even existence of acute kidney injury following intravenous iodinated contrast media injection during CT (23)(24)(25)(26)(27)).…”

Section: Low Dose Tavr Ctamentioning

confidence: 99%

“…Bittner et al reported good to excellent image quality with mean attenuation of 285±60 and 289±74 HU at the aortic annulus and iliac bifurcation respectively. The average iodinated contrast material (Iomeron 350) dose used in this study was 38 mL compared to a reference range of 80 and 120 mL for routine dose pre-TAVR CTA (20,29). Scan parameters included tube voltage 100 kV, 350 mAs, 2×192×0.6 mm 3 collimation, 250 ms rotation time and a pitch of 3.2.…”

Section: Low Dose Tavr Ctamentioning

confidence: 99%

“…A test bolus of 8 mL of contrast was used for assessing the bolus transit time and 30 mL (at 4 mL/s) contrast with 40 cc saline chase was used for subsequent CTA. Procedural success was achieved in 31 out of 35 patients who underwent TAVI following the lowdose planning scan (20). A drawback of this technique is single-phase evaluation of the aortic annulus as opposed to using the largest systolic phase available on a multiphase acquisition; re-sizing the annulus via transesophageal echocardiography at the time of the procedure can mitigate this disadvantage.…”

Section: Low Dose Tavr Ctamentioning

confidence: 99%

See 2 more Smart Citations

Noninvasive aortic imaging

Baliyan¹,

Verdini²,

Meyersohn³

2018

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

Section: Low Dose Tavr Ctamentioning

confidence: 99%

Section: Low Dose Tavr Ctamentioning

confidence: 99%

Section: Low Dose Tavr Ctamentioning

confidence: 99%

See 1 more Smart Citation

Noninvasive aortic imaging

Baliyan¹,

Verdini²,

Meyersohn³

2018

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

“…[20], [21], [22] These studies demonstrate that contrast agent injection can be minimized to 40–60 mL, providing acceptable image quality for the heart and of the entire aorta of TAVI candidates. However, only the minority of centers performing TAVI have the latest dual-source generation scanners available.…”

Section: Discussionmentioning

confidence: 78%

Image quality and contrast agent exposure in cardiac computed tomography angiography prior to transcatheter aortic valve implantation procedures using different acquisition protocols

Hofmann

Schuetz

Bekeredjian

et al. 2017

European Journal of Radiology Open

View full text Add to dashboard Cite

BackgroundECG-gated cardiac computed tomography angiography (CCTA) has found widespread use for prosthesis sizing before transcatheter aortic valve implantation (TAVI). However, still little data exists on the optimal scan-strategy in such patients. We hypothesized that prospectively triggered CCTA can enable the visualization of aortic valve structures and peripheral arteries with lower radiation and contrast agent exposure in patients considered for TAVI compared to retrospectively gated protocols.MethodsAll studies were performed using a 256 multi-detector single source CT (iCT Philips, Best, Netherlands). With the prospective protocol the whole volume from the heart to the iliofemoral arteries scanned using prospective triggering. With the retrospective protocol a first retrospectively gated scan was performed for the heart and the iliofemoral part was subsequently scanned using a second non-triggered scan. Image quality was assessed semi-quantitatively and signal-to-noise- (SNR) and contrast-to-noise-ratios (CNR) were obtained for all scans.ResultsProspective CCTA was performed in 74 and in 34 patients, respectively using non-tailored and BMI adapted scans, whereas retrospective CCTA was performed in 57 patients. Prospective scans required lower contrast agent administration compared to retrospective scans (71 ± 8 mL versus 91 ± 15 mL, p < 0.01) and resulted in lower radiation exposure (26 ± 7mSv for retrospective versus 15 ± 3mSv for non-tailored prospective versus 8 ± 4mSv for BMI-adapted prospective scans, p < 0.01). Visual image quality was better for the evaluation of aortic valve structures and similar for the assessment of iliofemoral anatomy with prospective versus retrospective scans. In addition, contrast density, SNR and CNR were higher in the ascending aorta with prospective versus retrospective CCTA (434 ± 98HU versus 349 ± 112HU; 35 ± 14 versus 24 ± 9 and 31 ± 11 versus 16 ± 7, p < 0.001 for all). Subsection analysis by heart rate groups demonstrated that both image quality and CNR were significantly higher in patients with prospective versus retrospective CCTA, irrespective of the heart rate during image acquisition.ConclusionProspectively triggered CCTA allows for improved visualization of aortic valve structures and peripheral arteries in patients scheduled for TAVI with simultaneously reduced contrast agent dose and radiation exposure. Therefore, this acquisition mode seems to be the preferred for the evaluation of patients considered for TAVI.

show abstract

“…In contrast-enhanced CT, new-generation, dual-source CT and dedicated CT protocols offer sufficient imaging data with low dose of contrast media. [12][13][14] We used a second-generation, dual-source CT scanner ( Somatom Definition Flash, Siemens Healthcare, Forchheim, Germany) with low tube current and 100 kV, which were suggested by the automatic exposure control software CareDose 4D (Siemens Healthcare). Magnetic resonance angiography (MRA) has been reported to be equivalent to contrast-enhanced CT for the calculation of aortic annulus 15,16) but inferior for the assessment of aortic valve calcification and access root.…”

Section: Discussionmentioning

confidence: 99%

Renoprotective Transcatheter Aortic Valve Implantation Without Contrast Media

et al. 2018

View full text Add to dashboard Cite

The therapeutic role of transcatheter aortic valve implantation (TAVI) in high surgical risk or inoperable cases has been established. Most of the candidates for TAVI are elderly and have multiple comorbidities including chronic kidney disease. However, contrast-enhanced computed tomography and coronary angiography, both of which require iodine contrast media, are essential for pre-procedural planning. In addition, TAVI could have adverse effects on kidney function including contrast media-induced nephrotoxicity. Acute kidney injury following TAVI has been reported to be related to poor prognosis. In a case with advanced renal dysfunction, we successfully avoided post-procedural acute kidney injury by performing pre-procedural evaluation using minimal contrast and TAVI without contrast media. If anatomical conditions and experiences of the heart team are adequate, renoprotective TAVI should be a favorable therapy for patients with aortic stenosis complicated by renal dysfunction.

show abstract

Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior to transcatheter aortic valve implantation

Cited by 49 publications

References 30 publications

Noninvasive aortic imaging

Noninvasive aortic imaging

Image quality and contrast agent exposure in cardiac computed tomography angiography prior to transcatheter aortic valve implantation procedures using different acquisition protocols

Renoprotective Transcatheter Aortic Valve Implantation Without Contrast Media

Contact Info

Product

Resources

About