title: Left ventricular contrast injection with rotational C-arm CT improves accuracy of aortic annulus measurement during cardiac catheterisation.
abstract: OBJECTIVE
  Introduction of a novel contrast injection protocol during rotational C-arm CT (RCT) in cardiac catheterisation of patients with aortic stenosis for aortic root assessment.
  
  
  RESULTS
  Fifty-two patients underwent RCT imaging with contrast injection performed either into the aorta (Ao-RCT, n=25) or into the left ventricle (LV-RCT, n=27). Aortic annulus diameters were assessed in a multiplanar reconstruction view and compared with corresponding multidetector computed tomography (MDCT). LV contrast injection additionally enabled measurement of the left ventricular outflow tract (LVOT). LV-RCT improved the accuracy of annulus measurements and correlated well with MDCT data in comparison with Ao-RCT and MDCT (r=0.91, r=0.76, respectively). The Bland-Altman analysis showed smaller differences in MDCT and LV-RCT annulus measurements than between MDCT and Ao-RCT (LV-RCT: mean=0.4 mm, limits of agreement -1.5-2.3 mm vs. Ao-RCT: mean=0.1 mm, limits of agreement -3.4-3.6 mm). The inter-observer agreement for the annulus measurements was significantly increased for LV-RCT as calculated by the intra-class coefficient (ICC=0.85) in comparison with Ao-RCT (ICC=0.52).
  
  
  CONCLUSIONS
  Cardiac catheterisation including LV-RCT offers complementary assessment of left ventricular function, aortic valve anatomy, coronary angiography and arterial access routes. LV-RCT for aortic root measurements shows better correlation to MDCT than standard Ao-RCT protocols.
authors.affiliation: Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Balzer
authors.forename: Yang Chul
authors.initials: YC
authors.lastname: Boering
authors.forename: Sabine
authors.initials: S
authors.lastname: Mollus
authors.forename: Meike
authors.initials: M
authors.lastname: Schmidt
authors.forename: Katharina
authors.initials: K
authors.lastname: Hellhammer
authors.forename: Patrick
authors.initials: P
authors.lastname: Kroepil
authors.forename: Ralf
authors.initials: R
authors.lastname: Westenfeld
authors.forename: Tobias
authors.initials: T
authors.lastname: Zeus
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Ulrich
authors.initials: U
authors.lastname: Steinseifer
authors.forename: Marc W
authors.initials: MW
authors.lastname: Merx
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles; D006439:Hemodynamics; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media