European Radiology

, Volume 27, Issue 5, pp 1944–1953 | Cite as

Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning

  • Lloyd M. Felmly
  • Carlo N. De Cecco
  • U. Joseph Schoepf
  • Akos Varga-Szemes
  • Stefanie Mangold
  • Andrew D. McQuiston
  • Sheldon E. Litwin
  • Richard R. BayerII
  • Thomas J. Vogl
  • Julian L. Wichmann
Cardiac

Abstract

Purpose

To investigate feasibility, image quality and safety of low-tube-voltage, low-contrast-volume comprehensive cardiac and aortoiliac CT angiography (CTA) for planning transcatheter aortic valve replacement (TAVR).

Materials and methods

Forty consecutive TAVR candidates prospectively underwent combined CTA of the aortic root and vascular access route (270 mgI/ml iodixanol). Patients were assigned to group A (second-generation dual-source CT [DSCT], 100 kV, 60 ml contrast, 4.0 ml/s flow rate) or group B (third-generation DSCT, 70 kV, 40 ml contrast, 2.5 ml/s flow rate). Vascular attenuation, noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were compared. Subjective image quality was assessed by two observers. Estimated glomerular filtration (eGFR) at CTA and follow-up were measured.

Results

Besides a higher body-mass-index in group B (24.8±3.8 kg/m2 vs. 28.1±5.4 kg/m2, P=0.0339), patient characteristics between groups were similar (P≥0.0922). Aortoiliac SNR (P=0.0003) was higher in group B. Cardiac SNR (P=0.0003) and CNR (P=0.0181) were higher in group A. Subjective image quality was similar (P≥0.213) except for aortoiliac image noise (4.42 vs. 4.12, P=0.0374). TAVR-planning measurements were successfully obtained in all patients. There were no significant changes in eGFR among and between groups during follow-up (P≥0.302).

Conclusion

TAVR candidates can be safely and effectively evaluated by a comprehensive CTA protocol with low contrast volume using low-tube-voltage acquisition.

Key Points

Third-generation dual-source CT facilitates low-tube-voltage acquisition.

TAVR planning can be performed with reduced contrast volume and radiation dose.

TAVR-planning CT did not result in changes in creatinine levels at follow-up.

TAVR candidates can be safely evaluated by comprehensive low-tube-voltage CT angiography.

Keywords

Aortic stenosis Aortoiliac CT angiography Contrast medium Dual-source CT Transcatheter aortic valve replacement 

Notes

Acknowledgements

The scientific guarantor of this publication is U. Joseph Schoepf. The authors of this manuscript declare relationships with the following companies: UJS is a consultant for and/or receives research support from Bayer, Bracco, GE Healthcare, Medrad and Siemens. The other authors have no conflicts of interest to disclose. This study was funded by a research grant from GE Healthcare (award number 12-VIS-003), who also provided contrast medium for this study. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

References

  1. 1.
    Smith CR, Leon MB, Mack MJ et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198CrossRefPubMedGoogle Scholar
  2. 2.
    Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA (2012) SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr 6:366–380CrossRefPubMedGoogle Scholar
  3. 3.
    Renker M, Varga-Szemes A, Schoepf UJ et al (2016) A non-contrast self-navigated 3-dimensional MR technique for aortic root and vascular access route assessment in the context of transcatheter aortic valve replacement: proof of concept. Eur Radiol 26:951–958CrossRefPubMedGoogle Scholar
  4. 4.
    Sucha D, Chamuleau SA, Symersky P et al (2016) Baseline MDCT findings after prosthetic heart valve implantation provide important complementary information to echocardiography for follow-up purposes. Eur Radiol 26:997–1006CrossRefPubMedGoogle Scholar
  5. 5.
    Peeters FE, Kietselaer BL (2016) Editorial to: Baseline MDCT findings after prosthetic heart valve implantation provide important complementary information to echocardiography for follow-up purposes by Sucha et al. Eur Radiol 26:1007–1008CrossRefPubMedGoogle Scholar
  6. 6.
    Blanke P, Euringer W, Baumann T et al (2010) Combined assessment of aortic root anatomy and aortoiliac vasculature with dual-source CT as a screening tool in patients evaluated for transcatheter aortic valve implantation. AJR Am J Roentgenol 195:872–881CrossRefPubMedGoogle Scholar
  7. 7.
    Apfaltrer P, Henzler T, Blanke P, Krazinski AW, Silverman JR, Schoepf UJ (2013) Computed tomography for planning transcatheter aortic valve replacement. J Thorac Imaging 28:231–239CrossRefPubMedGoogle Scholar
  8. 8.
    Blanke P, Schoepf UJ, Leipsic JA (2013) CT in transcatheter aortic valve replacement. Radiology 269:650–669CrossRefPubMedGoogle Scholar
  9. 9.
    Faggiano P, Frattini S, Zilioli V et al (2012) Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process. Int J Cardiol 159:94–99CrossRefPubMedGoogle Scholar
  10. 10.
    Bagur R, Webb JG, Nietlispach F et al (2010) Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 31:865–874CrossRefPubMedGoogle Scholar
  11. 11.
    Arnold SV, Lei Y, Reynolds MR et al (2014) Costs of periprocedural complications in patients treated with transcatheter aortic valve replacement: results from the placement of aortic transcatheter valve trial. Circ Cardiovasc Interv 7:829–836CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Azzalini L, Abbara S, Ghoshhajra BB (2014) Ultra-low contrast computed tomographic angiography (CTA) with 20-ml total dose for transcatheter aortic valve implantation (TAVI) planning. J Comput Assist Tomogr 38:105–109CrossRefPubMedGoogle Scholar
  13. 13.
    Zhang LJ, Qi L, Wang J et al (2014) Feasibility of prospectively ECG-triggered high-pitch coronary CT angiography with 30 ml iodinated contrast agent at 70 kVp: initial experience. Eur Radiol 24:1537–1546CrossRefPubMedGoogle Scholar
  14. 14.
    Meyer M, Haubenreisser H, Schoepf UJ et al (2014) Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 273:373–382CrossRefPubMedGoogle Scholar
  15. 15.
    Harris BS, De Cecco CN, Schoepf UJ et al (2015) Dual-source CT imaging to plan transcatheter aortic valve replacement: accuracy for diagnosis of obstructive coronary artery disease. Radiology 275:80–88CrossRefPubMedGoogle Scholar
  16. 16.
    Blanke P, Spira EM, Ionasec R et al (2014) Semiautomated quantification of aortic annulus dimensions on cardiac CT for TAVR. JACC Cardiovasc Imaging 7:320–322CrossRefPubMedGoogle Scholar
  17. 17.
    Blanke P, Russe M, Leipsic J et al (2012) Conformational pulsatile changes of the aortic annulus: impact on prosthesis sizing by computed tomography for transcatheter aortic valve replacement. JACC Cardiovasc Interv 5:984–994CrossRefPubMedGoogle Scholar
  18. 18.
    Commission E (1999) European Guidelines on Quality Criteria for Computed Tomography. Report EUR 16262, Brussels, BelgiumGoogle Scholar
  19. 19.
    Goetti R, Baumüller S, Feuchtner G et al (2010) High-Pitch Dual-Source CT Angiography of the Thoracic and Abdominal Aorta: Is Simultaneous Coronary Artery Assessment Possible? Am J Roentgenol 194:938–944CrossRefGoogle Scholar
  20. 20.
    Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Chen CM, Chu SY, Hsu MY, Liao YL, Tsai HY (2014) Low-tube-voltage (80 kVp) CT aortography using 320-row volume CT with adaptive iterative reconstruction: lower contrast medium and radiation dose. Eur Radiol 24:460–468CrossRefPubMedGoogle Scholar
  22. 22.
    Szucs-Farkas Z, Schaller C, Bensler S, Patak MA, Vock P, Schindera ST (2009) Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume: comparison of 80 kVp and 120 kVp protocols in a matched cohort. Invest Radiol 44:793–799CrossRefPubMedGoogle Scholar
  23. 23.
    Wichmann JL, Hu X, Kerl JM et al (2015) 70 kVp Computed Tomography Pulmonary Angiography: Potential for Reduction of Iodine Load and Radiation Dose. J Thorac Imaging 30:69–76CrossRefPubMedGoogle Scholar
  24. 24.
    Wuest W, Anders K, Schuhbaeck A et al (2012) Dual source multidetector CT-angiography before Transcatheter Aortic Valve Implantation (TAVI) using a high-pitch spiral acquisition mode. Eur Radiol 22:51–58CrossRefPubMedGoogle Scholar
  25. 25.
    Meinel FG, Canstein C, Schoepf UJ et al (2014) Image quality and radiation dose of low tube voltage 3rd generation dual-source coronary CT angiography in obese patients: a phantom study. Eur Radiol 24:1643–1650CrossRefPubMedGoogle Scholar
  26. 26.
    Jilaihawi H, Kashif M, Fontana G et al (2012) Cross-sectional computed tomographic assessment improves accuracy of aortic annular sizing for transcatheter aortic valve replacement and reduces the incidence of paravalvular aortic regurgitation. J Am Coll Cardiol 59:1275–1286CrossRefPubMedGoogle Scholar
  27. 27.
    Bittner DO, Arnold M, Klinghammer L et al. (2016) Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior to transcatheter aortic valve implantation. Eur Radiol [ePub ahead of print]Google Scholar
  28. 28.
    Kok M, Turek J, Mihl C et al. (2015) Low contrast media volume in pre-TAVI CT examinations. Eur Radiol [ePub ahead of print]Google Scholar
  29. 29.
    Nijssen EC, Vermeeren MA, Janssen MM et al (2012) Contrast material-induced nephropathy in the era of hydration. Radiology 265:978–979, author reply 979CrossRefPubMedGoogle Scholar
  30. 30.
    Wichmann JL, Katzberg RW, Litwin SE et al (2015) Contrast-Induced Nephropathy. Circulation 132:1931–1936CrossRefPubMedGoogle Scholar
  31. 31.
    McDonald JS, McDonald RJ, Carter RE, Katzberg RW, Kallmes DF, Williamson EE (2014) Risk of intravenous contrast material-mediated acute kidney injury: a propensity score-matched study stratified by baseline-estimated glomerular filtration rate. Radiology 271:65–73CrossRefPubMedGoogle Scholar
  32. 32.
    Weiland FL, Marti-Bonmati L, Lim L, Becker HC (2014) Comparison of patient comfort between iodixanol and iopamidol in contrast-enhanced computed tomography of the abdomen and pelvis: a randomized trial. Acta Radiol 55:715–724CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Lloyd M. Felmly
    • 1
    • 2
  • Carlo N. De Cecco
    • 1
  • U. Joseph Schoepf
    • 1
    • 3
  • Akos Varga-Szemes
    • 1
  • Stefanie Mangold
    • 1
    • 4
  • Andrew D. McQuiston
    • 1
  • Sheldon E. Litwin
    • 1
    • 3
  • Richard R. BayerII
    • 1
    • 3
  • Thomas J. Vogl
    • 5
  • Julian L. Wichmann
    • 1
    • 5
  1. 1.Division of Cardiovascular Imaging, Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  2. 2.Division of Cardiothoracic Surgery, Department of SurgeryMedical University of South CarolinaCharlestonUSA
  3. 3.Division of Cardiology, Department of MedicineMedical University of South CarolinaCharlestonUSA
  4. 4.Department of Diagnostic and Interventional RadiologyUniversity Hospital of TübingenTübingenGermany
  5. 5.Department of Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurtGermany

Personalised recommendations