title: Dual source multidetector CT-angiography before Transcatheter Aortic Valve Implantation (TAVI) using a high-pitch spiral acquisition mode.
abstract: OBJECTIVE
  Transcatheter Aortic Valve Implantation (TAVI) is an alternative to surgical valve replacement in high risk patients. Angiography of the aortic root, aorta and iliac arteries is required to select suitable candidates, but contrast agents can be harmful due to impaired renal function. We evaluated ECG-triggered high-pitch spiral dual source Computed Tomography (CT) with minimized volume of contrast agent to assess aortic root anatomy and vascular access.
  
  
  METHODS
  42 patients (82 ± 6 years) scheduled for TAVI underwent dual source (DS) CT angiography (CTA) of the aorta using a prospectively ECG-triggered high-pitch spiral mode (pitch = 3.4) with 40 mL iodinated contrast agent. We analyzed aortic root/iliac dimensions, attenuation, contrast to noise ratio (CNR), image noise and radiation exposure.
  
  
  RESULTS
  Aortic root/iliac dimensions and distance of coronary ostia from the annulus could be determined in all cases. Mean aortic and iliac artery attenuation was 320 ± 70 HU and 340 ± 77 HU. Aortic/iliac CNR was 21.7 ± 6.8 HU and 14.5 ± 5.4 HU using 100 kV (18.8 ± 4.1 HU and 8.7 ± 2.6 HU using 120 kV). Mean effective dose was 4.5 ± 1.2 mSv.
  
  
  CONCLUSIONS
  High-pitch spiral DSCTA can be used to assess the entire aorta and iliac arteries in TAVI candidates with a low volume of contrast agent while preserving diagnostic image quality.
authors.affiliation: Department of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Wuest
authors.forename: K
authors.initials: K
authors.lastname: Anders
authors.forename: A
authors.initials: A
authors.lastname: Schuhbaeck
authors.forename: M S
authors.initials: MS
authors.lastname: May
authors.forename: S
authors.initials: S
authors.lastname: Gauss
authors.forename: M
authors.initials: M
authors.lastname: Marwan
authors.forename: M
authors.initials: M
authors.lastname: Arnold
authors.forename: S
authors.initials: S
authors.lastname: Ensminger
authors.forename: G
authors.initials: G
authors.lastname: Muschiol
authors.forename: W G
authors.initials: WG
authors.lastname: Daniel
authors.forename: M
authors.initials: M
authors.lastname: Uder
authors.forename: S
authors.initials: S
authors.lastname: Achenbach
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016477:Artifacts; D015992:Body Mass Index; D006328:Cardiac Catheterization / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D017023:Coronary Angiography / Q000379:methods; D004562:Electrocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D061330:Multidetector Computed Tomography; D057234:Preoperative Period; D011446:Prospective Studies; D011829:Radiation Dosage; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media