Mangold Stefanie, De Cecco Carlo N, Schoepf U Joseph, Kuhlman Taylor S, Varga-Szemes Akos, Caruso Damiano, Duguay Taylor M, Tesche Christian, Vogl Thomas J, Nikolaou Konstantin, Steinberg Daniel H, Wichmann Julian L
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany.
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Eur J Radiol. 2017 Jan;86:276-283. doi: 10.1016/j.ejrad.2016.11.023. Epub 2016 Nov 27.
To assess image quality and accuracy of CT angiography (CTA) for transcatheter aortic valve replacement (TAVR) planning performed with 3rd generation dual-source CT (DSCT).
We evaluated 125 patients who underwent TAVR-planning CTA on 3rd generation DSCT. A two-part protocol was performed including retrospectively ECG-gated coronary CTA (CCTA) and prospectively ECG-triggered aortoiliac CTA using 60mL of contrast medium. Automated tube voltage selection and advanced iterative reconstruction were applied. Effective dose (ED), signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were calculated. Five-point scales were used for subjective image quality analysis. In patients who underwent TAVR, sizing parameters were obtained.
Image quality was rated good to excellent in 97.6% of CCTA and 100% of aortoiliac CTAs. CTA studies at >100kV showed decreased objective image quality compared to 70-100kV (SNR, all p≤0.0459; CNR, all p≤0.0462). Mean ED increased continuously from 70 to >100kV (CCTA: 4.5±1.7mSv-13.6±2.9mSv, all p≤0.0233; aortoiliac CTA: 2.4±0.9mSv-6.8±2.7mSv, all p≤0.0414). In 39 patients TAVR was performed and annulus diameter was within the recommended range in all patients. No severe cardiac or vascular complications were noted.
3rd generation DSCT provides diagnostic image quality in TAVR-planning CTA and facilitates reliable assessment of TAVR device and delivery option while reducing radiation dose.
评估使用第三代双源CT（DSCT）进行经导管主动脉瓣置换术（TAVR）规划时CT血管造影（CTA）的图像质量和准确性。
我们评估了125例接受第三代DSCT上TAVR规划CTA的患者。执行了一个两部分方案，包括回顾性心电图门控冠状动脉CTA（CCTA）和前瞻性心电图触发的腹主动脉CTA，使用60mL造影剂。应用自动管电压选择和先进的迭代重建技术。计算有效剂量（ED）、信噪比（SNR）和对比噪声比（CNR）。使用五点量表进行主观图像质量分析。在接受TAVR的患者中，获取尺寸参数。
97.6%的CCTA和100%的腹主动脉CTA的图像质量被评为良好至优秀。与70 - 100kV相比，>100kV的CTA研究显示客观图像质量下降（SNR，所有p≤0.0459；CNR，所有p≤0.0462）。平均ED从70kV到>100kV持续增加（CCTA：4.5±1.7mSv - 13.6±2.9mSv，所有p≤0.0233；腹主动脉CTA：2.4±0.9mSv - 6.8±2.7mSv，所有p≤0.0414）。39例患者接受了TAVR，所有患者的瓣环直径均在推荐范围内。未观察到严重的心脏或血管并发症。
第三代DSCT在TAVR规划CTA中提供了诊断图像质量，有助于对TAVR装置和输送方案进行可靠评估，同时降低辐射剂量。
