CT imaging before transcatheter aortic valve implantation (TAVI) using variable helical pitch scanning and its diagnostic performance for coronary artery disease
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To evaluate the effectiveness of CT before TAVI using variable helical pitch (VHP) scanning and its diagnostic performance for coronary artery disease (CAD).
Sixty patients (84.4 ± 4.6 years) scheduled for TAVI underwent CT using VHP scanning with the contrast material (CM) volume calculated as scanning time × weight [kg] × 0.06 mL. Retrospective electrocardiography (ECG)-gated scanning was utilized to examine the thorax, and non-ECG-gated scanning of the abdomen immediately followed. We analyzed CT attenuation values of the coronary arteries, aorta, iliac and femoral arteries. The coronary CT angiography images were evaluated for the presence of stenosis (≥50 %); invasive coronary angiography served as a reference standard.
The average attenuations of all of the arteries were greater than 400 HU. We could evaluate the peripheral access vessels and dimensions of the ascending aorta, aortic root, and aortic annulus in all patients. The average volume of CM was 38.7 ± 8.5 mL. On per-patient and vessel analysis, CT showed 91.7 % and 89.5 % sensitivity, and 91.3 % and 97.4 % negative predictive value (NPV).
CT using VHP scanning with an average CM volume of 38.7 mL is useful before TAVI and had a high sensitivity and NPV in excluding obstructive CAD.
• TAVI-planning CT using variable helical pitch (VHP) scanning is useful.
• The average volume of contrast material was 38.7 ± 8.5 mL.
• The average attenuations of all the arteries were >400 HU.
• This CT had a high sensitivity and NPV for excluding obstructive CAD.
KeywordsMultidetector computed tomography Contrast media Sensitivity and specificity Coronary artery disease Transcatheter aortic valve replacement
Coronary artery diseasec
Negative predictive value
Positive predictive value
Transcatheter aortic valve implantation
The scientific guarantor of this publication is Masahiro Jinzaki. Masahiro Jinzaki received a grant from Toshiba Medical Systems Japan. The remaining authors (Shunsuke Matsumoto, Yoshitake Yamada, Masahiro Hashimoto, Teppei Okamura, Minoru Yamada, Fumiaki Yashima, Kentaro Hayashida, and Keiichi Fukuda) have no financial disclosures to make and had complete unrestricted access to the study data at all stages of the study. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper.
Institutional review board approval was obtained. Written informed consent was obtained from all patients in this study. No study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.
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