Dual source multidetector CT-angiography before Transcatheter Aortic Valve Implantation (TAVI) using a high-pitch spiral acquisition mode

Wuest, Wolfgang; Anders, Katharina; Schuhbaeck, Annika; May, Matthias; Gauss, Soeren; Marwan, Mohamed; Arnold, Martin; Ensminger, Stephan; Muschiol, Gerd; Daniel, Werner G.; Uder, Michael; Achenbach, Stephan

doi:10.1007/s00330-011-2233-0

Cited by 102 publications

(51 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, the use of fast acquisition would allow reduction of contrast agent, which is again of paramount importance for longterm follow-up. Possibility of reducing volume of contrast agent has been recently reported with promising results (18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

High-pitch dual-source CT angiography without ECG-gating for imaging the whole aorta: intraindividual comparison with standard pitch single-source technique without ECG-gating

Manna¹,

Silva²,

Cobelli³

et al. 2017

Diagn Interv Radiol

View full text Add to dashboard Cite

C omputed tomography angiography (CTA) of the aorta is the reference method to investigate aortic disease and to follow up patients after surgical or endovascular aortic repair, either thoracic or abdominal. Thoracic aorta usually demands electrocardiography (ECG)-gated CTA to avoid motion artifacts related to cardiac cycle, notably for imaging aortic root and ascending segment (1). However, ECG-gating results in significantly increased radiation exposure, notably in case of low-pitch acquisition for retrospective reconstruction. Furthermore, ECG-gating technique is also related to significant increase of imaging time and volume of contrast agent.Dual-source (DS) hardware is a significant technological advance because it allows acquisition with exceptionally high-pitch and fast rotation speed, with substantial reduction of acquisition time and time resolution. For instance, DS-CTA with ECG-gating allows whole coronary imaging (scan length, 12-14 cm) in a single heart cycle with significant reduction in radiation dose and volume of contrast agent (2). Furthermore, DS-CTA with ECG-gating provides high quality images with minor motion artifacts also in imaging of whole thoracic aorta (scan length 20-30 cm) (3). Karlo et al. (4) demonstrated that high-pitch DS-CTA without ECG-gating provides diagnostic image quality of the aortic valve-aortic root complex similar to ECG-gated technique. Despite these advantages in acquisition of short vascular segments (e.g., coronary or thoracic aorta), the role of high-pitch DS-CTA in imaging the whole thoracoabdominal aorta still remains a challenge and a topic of debate (5-8) C A R D I O VA S C U L A R I MAG I N G O R I G I N A L A R T I C L E PURPOSEWe aimed to perform intraindividual comparison of computed tomography (CT) parameters, image quality, and radiation exposure between standard CT angiography (CTA) and high-pitch dual source (DS)-CTA, in subjects undergoing serial CTA of thoracoabdominal aorta. METHODSEighteen subjects with thoracoabdominal CTA by standard technique and high-pitch DS-CTA technique within 6 months of each other were retrieved for intraindividual comparison of image quality in thoracic and abdominal aorta. Quantitative analysis was performed by comparison of mean aortic attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Qualitative analysis was performed by visual assessment of motion artifacts and diagnostic confidence. Radiation exposure was quantified by effective dose. Image quality was apportioned to radiation exposure by means of figure of merit. RESULTSMean aortic attenuation and noise were higher in high-pitch DS-CTA of thoracoabdominal aorta, whereas SNR and CNR were similar in thoracic aorta and significantly lower in high-pitch DS-CTA of abdominal aorta (P = 0.024 and P = 0.016). High-pitch DS-CTA was significantly better in the first segment of thoracic aorta. Effective dose was reduced by 72% in high-pitch DS-CTA. CONCLUSIONHigh-pitch DS-CTA without electrocardiography-gating is an effective technique for...

show abstract

Section: Discussionmentioning

confidence: 99%

High-pitch dual-source CT angiography without ECG-gating for imaging the whole aorta: intraindividual comparison with standard pitch single-source technique without ECG-gating

Manna¹,

Silva²,

Cobelli³

et al. 2017

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…In principle, the lowest possible amount of contrast medium should be selected due to the renal insufficiency that is often present in patients prior to TAVI. Protocols with reduced amounts of contrast medium of up 50 ml for the above-mentioned scanning area are described in the literature [46]. However, such a low amount of contrast medium can only be achieved in the case of units with a very high scanning speed.…”

Section: Examination Protocolsmentioning

confidence: 99%

Role of Preprocedural Computed Tomography in Transcatheter Aortic Valve Implantation

Lehmkuhl

Foldyna

Haensig

et al. 2013

Fortschr Röntgenstr

View full text Add to dashboard Cite

Transcatheter aortic valve implantation (TAVI) is currently considered an acceptable alternative for the treatment of patients with severe aortic stenosis and a high perioperative risk or a contraindication for open surgery. The benefit of TAVI significantly outweighs the risk of the procedure in patients requiring treatment that are not suitable for open surgery, and leads to a lower mortality in the one-year follow-up.?The absence of a direct view of the aortic root and valve remains a challenge for the transcatheter approach. While direct inspection of the aortic valve during open surgery allows an adequate prosthesis choice, it is crucial for TAVI to know the individual anatomical details prior to the procedure in order to assure adequate planning of the procedure and proper prosthesis choice and patient selection. Among the imaging modalities available for the evaluation of patients prior to TAVI, computed tomography (CT) plays a central role in patient selection. CT reliably visualizes the dimensions of the aortic root and allows a proper choice of the prosthesis size. The morphology of the access path and relevant comorbidities can be assessed. The present review summarizes the current state of knowledge regarding the value of CT in the evaluation of patients prior to TAVI. Key Points: Citation Format:

show abstract

“…(32) MSCT is increasingly being used for the more demanding role of screening vascular access routes for TAVI. (33,34) The advantage is that an overview of all potential vascular access routes, including transfemoral, -subclavian or -apical may be obtained, (35) (Figure 4). In a combined scanning protocol the vascular overview can be obtained immediately following a scan of the heart without requiring additional contrast.…”

Section: Vascular Accessmentioning

confidence: 99%

“…(35) In addition to information on vascular luminal diameter MSCT provides a detailed overview of the 3 dimensional tortuosity and calcification of the vascular tree. All 3 these factors have to be considered when choosing the access route in order to deduce permissibility for the…”

Section: Vascular Accessmentioning

confidence: 99%

Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI)

Schultz

Jaegere

2017

SAHJ

View full text Add to dashboard Cite

Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI) and 3-D TEE can evaluate all anatomical aspects of the aortic root. (6)(7)(8) MSCT is particularly attractive for the evaluation of anatomy because it provides the user with a 3-D virtual representation that can be viewed from any angle or cut-plane after acquisition. What follows is a review of the role of MSCT pre-and post-TAVI. DIAGNOSIS OF SEVERE AORTIC STENOSISThe diagnosis of severe aortic stenosis is typically based on demonstrated that the LVOT is oval shaped, a fact which cannot be appreciated on 2-D echocardiography. (10,12,13,) In 3 separate studies the assumption of circularity of the LVOT was abandoned when using the continuity equation and instead the LVOT area measured on MSCT was used to replace the LVOT diameter from TTE for the calculation of AVA. (14,15,16)

show abstract

Dual source multidetector CT-angiography before Transcatheter Aortic Valve Implantation (TAVI) using a high-pitch spiral acquisition mode

Abstract: High-pitch spiral DSCTA can be used to assess the entire aorta and iliac arteries in TAVI candidates with a low volume of contrast agent while preserving diagnostic image quality.

Cited by 102 publications

References 35 publications

High-pitch dual-source CT angiography without ECG-gating for imaging the whole aorta: intraindividual comparison with standard pitch single-source technique without ECG-gating

High-pitch dual-source CT angiography without ECG-gating for imaging the whole aorta: intraindividual comparison with standard pitch single-source technique without ECG-gating

Role of Preprocedural Computed Tomography in Transcatheter Aortic Valve Implantation

Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI)

Contact Info

Product

Resources

About