Third Generation Dual Source Computed Tomography for Evaluation of Patients Prior to Transcatheter Aortic Valve Replacement: Comprehensive Imaging With an Ultra Low-Dose of Contrast Agent

Marwan, Mohamed; Achenbach, Stephan; Hell, Michaela M.; Schuhbaeck, Annika; Gauss, Soeren; Bittner, Daniel O.; Troebs, M

doi:10.1016/s0735-1097(15)61263-3

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“…One of these techniques is to use the ultra-high pitch mode (pitch higher than 3) available on dual-source scanners. They allow acquisition of the whole aorta with freezing of the aortic root within one single reduced CM bolus injection [ 20 ], which results in significant reduction of iodine dose (to as low as 10,5 g) and radiation dose (down to 250 mGy.cm) [ 20 ][ 21 ]. However, an accurate assessment of the aortic root annulus maximum size that is critical for TAVR planning is not possible by lack of retrospective ECG gating associated of these techniques.…”

Section: Discussionmentioning

confidence: 99%

320-row CT transcatheter aortic valve replacement planning with a single reduced contrast media bolus injection

et al. 2018

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ObjectiveTo reduce the iodine load required for CT Transcatheter Aortic Valve Replacement (TAVR) planning on a 320-row scanner by acquiring the two CT TAVR steps (ECG-gated aortic root CTA and non-gated aorto-ilio-femoral CTA) within a single contrast media bolus injection.Methods50 consecutive patients (82.6±6.9 years; 56% female) were prospectively enrolled and underwent a TAVR planning using a 320-row CT, with ECG-gated aortic root CTA immediately followed by a non-gated aorto-iliac acquisition, all within a single bolus of 40-70mL of Iohexol 350mgI/mL. The Iodine load, image quality, SNR, CNR and radiation dose were compared using a Mann-Whitney test to that of 24 consecutive patients (84.3±4.8 years, 58% female) previously imaged on a 64-row scanner with a conventional two-step protocol.ResultsIodine load was reduced by 44%. All examinations were of diagnostic quality, with improvement of the aortic root CTA image quality (4.9±0.3 versus 4.6±0.5, p<0.01) and a non-significant decrease of the aorto-iliac CTA image quality (4.7±0.6 versus 4.9±0.3, p = 0.07). SNR and CNR were significantly improved in the aortic root CTA (14.0±5.3 and 10.4±4.5 versus 10.3±4.2 and 6.8±3.3, p<0.01 for both) and non-significantly higher in the aorto-iliac CTA (16.5±8.0 and 14.1±7.9 versus 14.7±5.5 and 12.5±5.0, p = 0.42 and p = 0.66). Total radiation dose was reduced by 32%.Conclusion320-row CT scanner enables a 44% reduction of iodine load in TAVR planning, while maintaining excellent aorto-ilio-femoral arterial enhancement and lowering radiation dose.

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Section: Discussionmentioning

confidence: 99%