CT imaging prior to transcatheter aortic valve implantation in the UK

Harries, Iwan; Weir‐McCall, Jonathan R.; Williams, Michelle C.; Shambrook, James; Roditi, Giles; Bull, R K; Morgan‐Hughes, Gareth; Nicol, Edward; Moss, Alastair J

doi:10.1136/openhrt-2019-001233

Cited by 10 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our CT protocol, radiation exposure was already quite low with a median DLP of 410.5 mGy·cm. A cross-sectional observational study in the UK published in 2020 reported a median DLP of 675 mGy·cm for CT studies prior to TAVI ( 25 ). Considering that most TAVI candidates are multimorbid septuagenarians or octogenarians (median age was 80 years in our cohort), further reductions in radiation exposure in this population are unlikely to be of any benefit for the patients.…”

Section: Discussionmentioning

confidence: 99%

Improved image quality in transcatheter aortic valve implantation planning CT using deep learning-based image reconstruction

Heinrich¹,

Yücel²,

Böttcher³

et al. 2023

Quant Imaging Med Surg

View full text Add to dashboard Cite

Background: This study aims to evaluate the impact of a novel deep learning-based image reconstruction (DLIR) algorithm on the image quality in computed tomographic angiography (CTA) for pre-interventional planning of transcatheter aortic valve implantation (TAVI).Methods: We analyzed 50 consecutive patients (median age 80 years, 25 men) who underwent TAVI planning CT on a 256-dectector-row CT. Images were reconstructed with adaptive statistical iterative reconstruction (ASIR-V) and DLIR. Intravascular image noise, edge sharpness, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were quantified for ascending aorta, descending aorta, abdominal aorta and iliac arteries. Two readers (one radiologist and one interventional cardiologist) scored task-specific subjective image quality on a five-point scale.Results: DLIR significantly reduced median image noise by 29-57% at all anatomical locations (all P<0.001). Accordingly, median SNR improved by 44-133% (all P<0.001) and median CNR improved by 44-125% (all P<0.001). DLIR significantly improved subjective image quality for all four pre-specified TAVI-specific tasks (measuring the annulus, assessing valve morphology and calcifications, the coronary ostia, and the suitability of the aorto-iliac access route) for both the radiologist and the interventional cardiologist (P≤0.001). Measurements of the aortic annulus circumference, area and diameter did not differ between ASIR-V and DLIR reconstructions (all P>0.05).Conclusions: DLIR significantly improves objective and subjective image quality in TAVI planning CT compared to a state-of-the-art iterative reconstruction without affecting measurements of the aortic annulus. This may provide an opportunity for further reductions in contrast medium volume in this population.

show abstract

Section: Discussionmentioning

confidence: 99%

Improved image quality in transcatheter aortic valve implantation planning CT using deep learning-based image reconstruction

Heinrich¹,

Yücel²,

Böttcher³

et al. 2023

Quant Imaging Med Surg

View full text Add to dashboard Cite

show abstract

“…Schicchi et al 4 and Kok et al 8 used DSCT with a single prospective ECG-triggered acquisition and DSCT, with a retrospective ECG-triggered acquisition and a shorter scanning length. The study by Harries et al 5 collected protocols from many institutes, consisting of many types of scanners and techniques. The report showed a wide range of effective radiation doses in CT-pre TAVI.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Radiation Dose in Computed Tomography Angiography before Transcatheter Aortic Valve Implantation

Ritlumlert

Tweeatsani

Jongjirasiri

et al. 2022

J Health Sci Med Res

View full text Add to dashboard Cite

Objective: To investigate the effective radiation dose and image quality of computed tomography angiography (CTA) before transcatheter aortic valve implantation (TAVI). Material and Methods: This study involved 65 participants, diagnosed with aortic valve stenosis and examined with CTA before TAVI. The total mAs, kVp, volume CT dose index (CTDIvol), and dose–length product (DLP) in each scanning phase were recorded. The effective dose was calculated by multiplying the DLP by the conversion coefficient (k=0.015 mSv/[mGy.cm]). For quantitative image analysis, circular regions of interest were placed on six levels of the aorta in the axial images. The CT attenuation value, image noise, signal-to-noise ratio, and contrast-to-noise ratio were measured. For qualitative analysis, two radiologists rated the image quality of the aortic root and aortoiliac pathway. Results: The mean CTDIvol and DLP were 23.59±5.19 mGy and 881.01±193.41 mGy.cm., respectively. The mean effective dose was 13.22±2.90 mSv; the whole-aorta CTA phase received the highest dose, followed by the coronary CTA and coronary artery calcium scoring phases (9.62±2.60, 2.44±1.13, and 1.16±0.55 mSv, respectively). Image quality ranged from good to excellent in all segments of the aorta. Conclusion: The mean effective radiation dose of the pre-TAVI CT examination using 256-multidetector CT was 22.91± 5.03 mSv. The image quality in the aorta was good to excellent. The main factors that affected the radiation dose were: body mass index, total mAs, and kVp.

show abstract

“…Preliminary planning based on multidimensional imaging is key to achieve favorable outcomes during the procedure as well as subsequently, with multidetector contrast-enhanced computed tomography (CT) playing a central role 6 – 9 . The benefits of CT include accurate appraisal of vessel dimensions, angles and calcifications, suitable for decision-making in terms of procedural details as well as TAVI device type and size, on top of overall risk assessment and prediction of complications such as permanent pacemaker implantation or prosthesis-patient mismatch 10 – 18 .…”

Section: Introductionmentioning

confidence: 99%

“…The benefits of CT include accurate appraisal of vessel dimensions, angles and calcifications, suitable for decision-making in terms of procedural details as well as TAVI device type and size, on top of overall risk assessment and prediction of complications such as permanent pacemaker implantation or prosthesis-patient mismatch 10 – 18 . However, CT exams may provide a confounding and overwhelming plethora of parameters and measurements, limiting the eventual informativeness of a CT report, leading to inappropriate decisions and strategies, with several apparently useful features actually proving of limited predictive accuracy 9 , 19 .…”

Section: Introductionmentioning

confidence: 99%

TAVI-CT score to evaluate the anatomic risk in patients undergoing transcatheter aortic valve implantation

Corcione

Morello

Ferraro³

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Transcatheter aortic valve implantation (TAVI) requires thorough preprocedural planning with non-invasive imaging, including computed tomography (CT). The plethora of details obtained with thoraco-abdominal CT represents a challenge for accurate and synthetic decision-making. We devised and tested a comprehensive score suitable to summarize CT exams when planning TAVI. An original comprehensive scoring system (TAVI-CT score) was devised, including details on cardiac, aortic, iliac and femoral artery features. The score was applied to a prospectively collected series of patients undergoing TAVI at our institution, driving decision making on access and prosthesis choice. Different TAVI-CT score groups were compared in terms of procedural success, acute complications, and early clinical outcomes. We included a total of 200 undergoing TAVI between February 2020 and May 2021, with 74 (37.0%) having a low (0–2) TAVI-CT score, 50 (25.0%) having a moderate (3) TAVI-CT score, and 76 (38.0%) having a high (≥ 4) TAVI-CT score. Male gender was the only non-CT variable significantly associated with the TAVI-CT score (p = 0.001). As expected, access choice differed significantly across TAVI-CT scores (p = 0.009), as was device choice, with Portico more favored and Allegra less favored in the highest TAVI-CT score group (p = 0.036). Acute outcomes were similar in the 3 groups, including device and procedural success rates (respectively p = 0.717 and p = 1). One-month follow-up showed similar rates of death, myocardial infarction, stroke, and bleeding, as well as of a composite safety endpoint (all p > 0.05). However, vascular complications were significantly more common in the highest TAVI-CT score group (p = 0.041). The TAVI-CT score is a simple scoring system that could be routinely applied to CT imaging for TAVI planning, if the present hypothesis-generating findings are confirmed in larger prospective studies.

show abstract

CT imaging prior to transcatheter aortic valve implantation in the UK

Cited by 10 publications

References 21 publications

Improved image quality in transcatheter aortic valve implantation planning CT using deep learning-based image reconstruction

Improved image quality in transcatheter aortic valve implantation planning CT using deep learning-based image reconstruction

Evaluation of Radiation Dose in Computed Tomography Angiography before Transcatheter Aortic Valve Implantation

TAVI-CT score to evaluate the anatomic risk in patients undergoing transcatheter aortic valve implantation

Contact Info

Product

Resources

About