Purpose: Adaptation of computed tomography protocols for transcatheter aortic valve implantation (TAVI) planning is required when a first-generation dual-layer spectral CT scanner (DLCT) is used. The purpose of this study was to evaluate the objective image quality of aortic CT angiography (CTA) for TAVI planning using a split-phase technique with reconstruction of 40 keV virtual monoenergetic images (40 keV-VMI) obtained with a DLCT scanner. CT angiography obtained with a single-phase protocol of a conventional single-detector CT (SLCT) was used for comparison.
Materials And Methods: 75 CTA scans from DLCT were retrospectively compared to 75 CTA scans from SLCT. For DLCT, spiral CTA without ECG-synchronization was performed immediately after a retrospectively ECG-gated acquisition covering the heart and aortic arch. For SLCT, spiral CTA with retrospective ECG-gating was performed to capture the heart and the access route simultaneously in one scan. Objective image quality was compared at different levels of the arterial access route.
Results: 40 keV virtual monoenergetic images of DLCT showed a significantly higher mean vessel attenuation, SNR, and CNR at all levels of the arterial access route. With 40 keV-VMI of DLCT, the overall mean aortic attenuation of all six measured regions was 589.6 ± 243 HU compared to 492.7 ± 209 HU of SLCT (p < 0.01). A similar trend could be observed for SNR (23.6 ± 18 vs. 18.6 ± 9; p < 0.01) and CNR (21.1 ± 18 vs. 16.4 ± 8; p < 0.01). No deterioration was observed for vascular noise (27.8 ± 9 HU vs. 28.1 ± 8 HU; p = 0.599).
Conclusion: Using a DLCT scanner with a split-phase protocol and 40 keV-VMI for TAVI planning, higher objective image quality can be obtained compared to a single-phase protocol of a conventional CT scanner.
Key Points: · Adaption of TAVI planning CT protocols may be required when using a first-generation dual-layer CT scanner.. · Reconstruction of virtual monoenergetic images at 40 keV improves image quality.. · With a split-phase protocol, the radiation dose is lower compared to a single-phase ECG-gated CT acquisition..
Citation Format: · Mangold D, Salatzki J, Riffel J et al. Dual-Layer Spectral CTA for TAVI Planning Using a Split-Phase Protocol and Low-keV Virtual Monoenergetic Images: Improved Image Quality in Comparison with Single-Phase Conventional CTA. Fortschr Röntgenstr 2022; 194: 652 - 659.
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http://dx.doi.org/10.1055/a-1717-2542 | DOI Listing |
Hellenic J Cardiol
January 2025
Department of Cardiology, University Hospital of Split, 21000 Split, Croatia. Electronic address:
Background: Anatomic considerations of transcatheter aortic valve implantation (TAVI) have an important role for the procedure planning, but sex-specific data are lacking.
Methods: All eligible cases undergoing evaluation for TAVI procedure in the period from November 2019 to July 2023 at the University Hospital of Split were included. Cardiac computed tomography was analysed to derive the measures of left ventricular outflow tract (LVOT), aortic root, ascending aorta, and ilio-femoral arteries.
Open Heart
January 2025
Massachusetts General Hospital, Boston, Massachusetts, USA.
Background: Accurate mortality prediction following transcatheter aortic valve implantation (TAVI) is essential for mitigating risk, shared decision-making and periprocedural planning. Surgical risk models have demonstrated modest discriminative value for patients undergoing TAVI and are typically poorly calibrated, with incremental improvements seen in TAVI-specific models. Machine learning (ML) models offer an alternative risk stratification that may offer improved predictive accuracy.
View Article and Find Full Text PDFOpen Heart
January 2025
Department of Cardiology, Leeds General Infirmary, Leeds, UK
Background: Increasing demand for transcatheter aortic valve implantation (TAVI) places greater emphasis on the efficiency of pathways and services. A significant limitation to increasing TAVI capacity is the availability of cardiac catheterisation laboratory time. We have developed a novel complexity scoring system (TAVI ComplEXity; TEX score) which can aid in planning lists with appropriate case selection.
View Article and Find Full Text PDFEur Radiol
December 2024
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Objectives: Screening for obstructive coronary artery disease (CAD) with coronary computed tomography angiography (CCTA) could prevent unnecessary invasive coronary angiography (ICA) procedures during work-up for trans-catheter aortic valve implantation (TAVI). CT-derived fractional flow reserve (CT-FFR) improves CCTA accuracy in chest pain patients. However, its reliability in the TAVI population is unknown.
View Article and Find Full Text PDFInt J Cardiol Heart Vasc
February 2025
Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
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