Transcatheter Aortic Valve Implantation (TAVI) Planning with Dual-Layer Spectral CT Using Virtual Monoenergetic Image (VMI) Reconstructions and 20 mL of Contrast Media.
Federico FontanaFilippo PiacentinoAroa GnesuttaEdoardo MacchiAndrea CoppolaAngiola SaccomannoTonia GattaChiara RecaldiniManuela MinennaClaudio TamboriniFilippo DossiVelio AscentiSimone BarberaGiuseppe CiceroGiulio CarcanoGiorgio AscentiBattistina CastiglioniMassimo VenturiniPublished in: Journal of clinical medicine (2024)
Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical implantation and its implementation is progressively increasing worldwide. We routinely perform pre-procedural aortic angiography CT to assess aortic dimensions and vascular anatomy. This study aims to evaluate the image quality of CTA for TAVI planning using dual-layer spectral CT, with virtual monoenergetic image reconstructions at 40 keV. Thirty-one patients underwent a CTA protocol with the injection of 20 mL of contrast media. Image quality was assessed by measuring the mean density in Hounsfield Units (HU), the signal-to-noise ratio, and the contrast-to-noise ratio in VMI reconstructions. Additionally, a blinded subjective analysis was conducted by two observers. The results showed significant enhancement at all sampled vascular levels with a gradual decrease in HU from proximal to distal regions. Favourable subjective ratings were given for all parameters, with greater variability in the evaluation of iliac axes. A significant negative correlation ( p < 0.05) was observed between BMI and CA at all vascular levels, indicating reduced contrast enhancement with increasing BMI. Spectral CT, along with reducing iodine load, allows for obtaining high-quality images without a significant increase in noise. The reduction in iodine load can have positive implications in clinical practice, improving patient safety and resource efficiency.
Keyphrases
- image quality
- dual energy
- transcatheter aortic valve implantation
- aortic valve
- computed tomography
- contrast enhanced
- aortic stenosis
- aortic valve replacement
- patient safety
- ejection fraction
- transcatheter aortic valve replacement
- magnetic resonance
- optical coherence tomography
- deep learning
- magnetic resonance imaging
- end stage renal disease
- air pollution
- left ventricular
- positron emission tomography
- clinical practice
- quality improvement
- body mass index
- chronic kidney disease
- healthcare
- randomized controlled trial
- primary care
- convolutional neural network
- minimally invasive
- study protocol
- physical activity
- peritoneal dialysis
- ultrasound guided
- patient reported outcomes
- endovascular treatment
- coronary artery
- pulmonary arterial hypertension
- atrial fibrillation