Using DynaCT for the assessment of ilio-femoral arterial calibre, calcification and tortuosity index in patients selected for trans-catheter aortic valve replacement.
Adequate vascular access for femoral trans-catheter aortic valve replacement is fundamental to the success of the procedure. Assessment of vascular calibre, tortuosity and calcification is performed by angiography and multi-slice computed tomography (MSCT). Can DynaCT provide the same information as MSCT? 15 Patients underwent MSCT, angiography and DynaCT. Vessel diameter measurements were taken in three positions of the left and right ilio-femoral arteries. Tortuosity was assessed using an index of the direct distance and the distance taken by the artery between two points. Calcification was assessed in MSCT and DynaCT using a simple scoring system. Concordance correlation coefficient of arterial calibre between angiography and MSCT was 0.96 (95 % CI 0.94-0.97). DynaCT and angiography was 0.94 (95 % CI 0.91-0.96) and Dyna CT and MSCT, 0.95 (95 % CI 0.92-0.97). Bland-Altman tests demonstrate a mean difference between the angiogram and the MSCT of 0.06 mm (+0.97, -1.42), angiogram and DynaCT, 0.13 mm, (+1.00, -0.87), DynaCT and MSCT, 0.2 mm, (+1.15, -0.76). Tortuosity comparisons gave a median tortuosity index for MSCT 1.29 and DynaCT 1.23 (p = 0.472). Calcification comparisons of MSCT and DynaCT using correlation coefficients demonstrate a correlation of 0.245 (p = 0.378). Effective radiation doses were: DynaCT; 3.63 ± 0.65 mSv and angiography; 0.57 ± 0.72 mSv, MSCT; 7.15 ± 2.58 mSv. DynaCT is equal to MSCT and angiography in assessing femoral artery calibre. Like MSCT, it can assess tortuosity and can produce 3D images but is inferior in the assessment of calcification.
Cardiac Investigations Unit, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia, Jimcrowhurst@hotmail.com.
James A
JA
Crowhurst
Douglas
D
Campbell
Owen C
OC
Raffel
Mark
M
Whitby
Pavthrun
P
Pathmanathan
Stanley
S
Redmond
Alexander
A
Incani
Karl
K
Poon
Christopher
C
James
Constantine
C
Aroney
Andrew
A
Clarke
Darren L
DL
Walters
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D006328:Cardiac Catheterization; D003287:Contrast Media; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D021621:Imaging, Three-Dimensional; D008297:Male; D061330:Multidetector Computed Tomography; D018579:Patient Selection; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000000981:diagnostic imaging*
D003287:Contrast Media