CT angiography prior to TaVI procedure using third-generation scanner with wide volume coverage: Feasibility, renal safety and diagnostic accuracy for coronary tree

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Abstract

Objective: To evaluate feasibility, image quality and accuracy of a reduced contrast volume protocol for pre-procedural CT imaging in transcatheter aortic valve implantation (TAVI) using a third generation wide array CT scanner. Methods: 115 consecutive patients (51F, mean age 82.5 ± 6.2 y, mean BMI 26.7 ± 3.6) referred for TAVI were examined with wide-array CT scanner with a combined scan protocol and a total amount of 50 ml contrast agent. A 4-point visual scale (4-1) was used to assess image quality . Contrast attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the level of the aortic root, ascending/ descending aorta, subrenal aorta and at the level of right and left common femoral arteries. Coronary tree was assessed and compared with invasive coronary angiography (ICA). Aortic annulus measurements were compared with final procedural results. Patients creatinine was monitored at the baseline and 72 h after procedure. results: Median quality score value was >3. Mean CNR at the level of the aortic root, ascending/descending aorta, subrenal aorta and at the level of right and left common femoral arteries were 14.8 ± 2.3, 15.7 ± 1.7, 14.9 ± 3.1, 15.8 ± 4.7, 20.3 ± 9.9, 20.8 ± 6.9 respectively. Only 1 patient had moderate paravalvular regurgitation. In comparison with ICA for coronary assessment CTA showed in a segment based analysis sensitivity, specificity, negative predictive value, positive predictive value and accuracy of 97, 85, 99,62 and 88% respectively. Mean creatinine before CT and 72 h after procedure were 1.21 ± 0.52 and1.22 ± 0.49 mg dl−1. Mean DLP was 442.4 ± 21.2 mGy/cm. Conclusion: CT with low contrast volume is feasible and clinically useful, allowing precise pre-procedural TAVI planning with accurate assessment of coronary tree. advances in knowledge: third generation CT scanner with whole heart coverage allows examinations for assessment of aorta and coronary arteries in TAVI planning using low dose of contrast medium maintaining good quality and high diagnostic accuracy.

Original languageEnglish
Article number20180196
JournalBritish Journal of Radiology
Volume91
Issue number1090
DOIs
Publication statusPublished - Jan 1 2018

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Aorta
Kidney
Safety
Femoral Artery
Coronary Angiography
Thoracic Aorta
Contrast Media
Noise
Creatinine
Coronary Vessels
Computed Tomography Angiography
Sensitivity and Specificity
Transcatheter Aortic Valve Replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{01b429ab202f45f79827f02c3ac2dfed,
title = "CT angiography prior to TaVI procedure using third-generation scanner with wide volume coverage: Feasibility, renal safety and diagnostic accuracy for coronary tree",
abstract = "Objective: To evaluate feasibility, image quality and accuracy of a reduced contrast volume protocol for pre-procedural CT imaging in transcatheter aortic valve implantation (TAVI) using a third generation wide array CT scanner. Methods: 115 consecutive patients (51F, mean age 82.5 ± 6.2 y, mean BMI 26.7 ± 3.6) referred for TAVI were examined with wide-array CT scanner with a combined scan protocol and a total amount of 50 ml contrast agent. A 4-point visual scale (4-1) was used to assess image quality . Contrast attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the level of the aortic root, ascending/ descending aorta, subrenal aorta and at the level of right and left common femoral arteries. Coronary tree was assessed and compared with invasive coronary angiography (ICA). Aortic annulus measurements were compared with final procedural results. Patients creatinine was monitored at the baseline and 72 h after procedure. results: Median quality score value was >3. Mean CNR at the level of the aortic root, ascending/descending aorta, subrenal aorta and at the level of right and left common femoral arteries were 14.8 ± 2.3, 15.7 ± 1.7, 14.9 ± 3.1, 15.8 ± 4.7, 20.3 ± 9.9, 20.8 ± 6.9 respectively. Only 1 patient had moderate paravalvular regurgitation. In comparison with ICA for coronary assessment CTA showed in a segment based analysis sensitivity, specificity, negative predictive value, positive predictive value and accuracy of 97, 85, 99,62 and 88{\%} respectively. Mean creatinine before CT and 72 h after procedure were 1.21 ± 0.52 and1.22 ± 0.49 mg dl−1. Mean DLP was 442.4 ± 21.2 mGy/cm. Conclusion: CT with low contrast volume is feasible and clinically useful, allowing precise pre-procedural TAVI planning with accurate assessment of coronary tree. advances in knowledge: third generation CT scanner with whole heart coverage allows examinations for assessment of aorta and coronary arteries in TAVI planning using low dose of contrast medium maintaining good quality and high diagnostic accuracy.",
author = "Annoni, {Andrea D.} and Daniele Andreini and Gianluca Pontone and Mancini, {Maria Elisabetta} and Alberto Formenti and Saima Mushtaq and Andrea Baggiano and Edoardo Conte and Marco Guglielmo and GIuseppe Muscogiuri and Manuela Muratori and Laura Fusini and Daniela Trabattoni and Giovanni Teruzzi and {Coutinho Santos}, {Ana I.} and Marco Agrifoglio and Mauro Pepi",
year = "2018",
month = "1",
day = "1",
doi = "10.1259/bjr.20180196",
language = "English",
volume = "91",
journal = "British Journal of Radiology",
issn = "0007-1285",
publisher = "British Institute of Radiology",
number = "1090",

}

TY - JOUR

T1 - CT angiography prior to TaVI procedure using third-generation scanner with wide volume coverage

T2 - Feasibility, renal safety and diagnostic accuracy for coronary tree

AU - Annoni, Andrea D.

AU - Andreini, Daniele

AU - Pontone, Gianluca

AU - Mancini, Maria Elisabetta

AU - Formenti, Alberto

AU - Mushtaq, Saima

AU - Baggiano, Andrea

AU - Conte, Edoardo

AU - Guglielmo, Marco

AU - Muscogiuri, GIuseppe

AU - Muratori, Manuela

AU - Fusini, Laura

AU - Trabattoni, Daniela

AU - Teruzzi, Giovanni

AU - Coutinho Santos, Ana I.

AU - Agrifoglio, Marco

AU - Pepi, Mauro

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To evaluate feasibility, image quality and accuracy of a reduced contrast volume protocol for pre-procedural CT imaging in transcatheter aortic valve implantation (TAVI) using a third generation wide array CT scanner. Methods: 115 consecutive patients (51F, mean age 82.5 ± 6.2 y, mean BMI 26.7 ± 3.6) referred for TAVI were examined with wide-array CT scanner with a combined scan protocol and a total amount of 50 ml contrast agent. A 4-point visual scale (4-1) was used to assess image quality . Contrast attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the level of the aortic root, ascending/ descending aorta, subrenal aorta and at the level of right and left common femoral arteries. Coronary tree was assessed and compared with invasive coronary angiography (ICA). Aortic annulus measurements were compared with final procedural results. Patients creatinine was monitored at the baseline and 72 h after procedure. results: Median quality score value was >3. Mean CNR at the level of the aortic root, ascending/descending aorta, subrenal aorta and at the level of right and left common femoral arteries were 14.8 ± 2.3, 15.7 ± 1.7, 14.9 ± 3.1, 15.8 ± 4.7, 20.3 ± 9.9, 20.8 ± 6.9 respectively. Only 1 patient had moderate paravalvular regurgitation. In comparison with ICA for coronary assessment CTA showed in a segment based analysis sensitivity, specificity, negative predictive value, positive predictive value and accuracy of 97, 85, 99,62 and 88% respectively. Mean creatinine before CT and 72 h after procedure were 1.21 ± 0.52 and1.22 ± 0.49 mg dl−1. Mean DLP was 442.4 ± 21.2 mGy/cm. Conclusion: CT with low contrast volume is feasible and clinically useful, allowing precise pre-procedural TAVI planning with accurate assessment of coronary tree. advances in knowledge: third generation CT scanner with whole heart coverage allows examinations for assessment of aorta and coronary arteries in TAVI planning using low dose of contrast medium maintaining good quality and high diagnostic accuracy.

AB - Objective: To evaluate feasibility, image quality and accuracy of a reduced contrast volume protocol for pre-procedural CT imaging in transcatheter aortic valve implantation (TAVI) using a third generation wide array CT scanner. Methods: 115 consecutive patients (51F, mean age 82.5 ± 6.2 y, mean BMI 26.7 ± 3.6) referred for TAVI were examined with wide-array CT scanner with a combined scan protocol and a total amount of 50 ml contrast agent. A 4-point visual scale (4-1) was used to assess image quality . Contrast attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the level of the aortic root, ascending/ descending aorta, subrenal aorta and at the level of right and left common femoral arteries. Coronary tree was assessed and compared with invasive coronary angiography (ICA). Aortic annulus measurements were compared with final procedural results. Patients creatinine was monitored at the baseline and 72 h after procedure. results: Median quality score value was >3. Mean CNR at the level of the aortic root, ascending/descending aorta, subrenal aorta and at the level of right and left common femoral arteries were 14.8 ± 2.3, 15.7 ± 1.7, 14.9 ± 3.1, 15.8 ± 4.7, 20.3 ± 9.9, 20.8 ± 6.9 respectively. Only 1 patient had moderate paravalvular regurgitation. In comparison with ICA for coronary assessment CTA showed in a segment based analysis sensitivity, specificity, negative predictive value, positive predictive value and accuracy of 97, 85, 99,62 and 88% respectively. Mean creatinine before CT and 72 h after procedure were 1.21 ± 0.52 and1.22 ± 0.49 mg dl−1. Mean DLP was 442.4 ± 21.2 mGy/cm. Conclusion: CT with low contrast volume is feasible and clinically useful, allowing precise pre-procedural TAVI planning with accurate assessment of coronary tree. advances in knowledge: third generation CT scanner with whole heart coverage allows examinations for assessment of aorta and coronary arteries in TAVI planning using low dose of contrast medium maintaining good quality and high diagnostic accuracy.

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U2 - 10.1259/bjr.20180196

DO - 10.1259/bjr.20180196

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VL - 91

JO - British Journal of Radiology

JF - British Journal of Radiology

SN - 0007-1285

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