title: Low-volume contrast medium protocol for comprehensive cardiac and aortoiliac CT assessment in the context of transcatheter aortic valve replacement.
abstract: OBJECTIVE
  To investigate the diagnostic performance of a comprehensive computed tomography (CT) protocol for both cardiac and aortoiliac evaluation of patients considered for transcatheter aortic valve replacement (TAVR) using a single, low-volume contrast medium (CM) injection.
  
  
  METHODS
  Forty-four TAVR candidates were retrospectively analyzed. All underwent retrospectively electrocardiogram-gated cardiac CT followed by high-pitch CT angiography of the aortoiliac vasculature using one of two single injection protocols of 320 mgI/mL iodine CM: group A (n = 22), iodine delivery rate-based (1.28 gI/s), 60-mL CM volume, 4.0 mL/s flow rate; group B (n = 22), clinical routine protocol, 100-mL CM volume, 4.0 mL/s flow rate. Mean arterial attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was assessed.
  
  
  RESULTS
  Aortic root and iliofemoral dimensions could be analyzed in all cases. Patient characteristics showed no significant differences. Mean attenuation at the levels of the aortic root (285.8 ± 83.0 HU vs 327.5 ± 70.8 HU, P = .080) and the iliofemoral access route (256.8 ± 88.5 HU vs 307.5 ± 93.2 HU, P = .071), as well as SNR and CNR were nonsignificantly lower in group A compared to group B. Subjective image quality was equivalent.
  
  
  CONCLUSIONS
  In multimorbid TAVR patients, the performance of a combined CT protocol using a single low-volume CM bolus is feasible with maintained image quality compared to a standard protocol.
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
authors.forename: Lucas L
authors.initials: LL
authors.lastname: Geyer
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260.
authors.forename: Carlo Nicola
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Silverman
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260.
authors.forename: Aleksander W
authors.initials: AW
authors.lastname: Krazinski
authors.affiliation: Department of Radiology, University of Tuebingen, Tuebingen, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.affiliation: Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D001027:Aortography / Q000379:methods*; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods; D000072226:Computed Tomography Angiography / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D010347:Patient Care Planning; D011829:Radiation Dosage; D012189:Retrospective Studies; D059629:Signal-To-Noise Ratio; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D014283:Triiodobenzoic Acids / Q000008:administration & dosage
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol
keywords: Aortic stenosis; aortoiliac CT angiography; contrast medium; dual-source CT; transcatheter aortic valve replacement