title: Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior to transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Chronic renal failure is common in patients referred for transcatheter aortic valve implantation (TAVI). CT angiography is recommended and provides crucial information prior to TAVI. We evaluated the feasibility of a reduced contrast volume protocol for pre-procedural CT imaging.
  
  
  METHODS
  Forty consecutive patients were examined with prospectively ECG-triggered high-pitch spiral acquisition using a novel third-generation dual-source CT system; 38 ml contrast agent was used. Image quality was graded on a visual scale (1-4). Contrast attenuation was measured at the level of the aortic root and at the iliac bifurcation.
  
  
  RESULTS
  Mean patient age was 82 ± 6 years (23 males; 58 %). Mean attenuation/average image quality was 285 ± 60 HU/1.5 at the aortic annulus compared to 289 ± 74 HU/1.8 at the iliac bifurcation (p = 0.77/p = 0.29). Mean estimated effective radiation dose was 2.9 ± 0.3 mSv. A repeat acquisition was necessary in one patient due to image quality. Out of the 35 patients who underwent TAVI, 31 (89 %) patients had no or mild aortic regurgitation. Thirty-two (91 %) patients were discharged successfully.
  
  
  CONCLUSIONS
  Pre-procedural CTA with a total of 38 ml contrast volume is feasible and clinically useful, using third-generation dual-source CT, allowing comprehensive imaging for procedural success.
  
  
  CONCLUSIONS
  • Reduction of contrast agent volume is crucial in patients with chronic renal failure. • Novel third-generation computed tomography helps to reduce contrast agent volume. • Pre-procedural CT allows comprehensive imaging for procedural success before heart valve implantation. • A low-contrast CT protocol is feasible for pre-procedural TAVI planning.
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Internal Medicine 2 (Cardiology), University Hospital Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany. daniel.bittner@uk-erlangen.de.|Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. daniel.bittner@uk-erlangen.de.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Bittner
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Internal Medicine 2 (Cardiology), University Hospital Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Arnold
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Internal Medicine 2 (Cardiology), University Hospital Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Klinghammer
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Internal Medicine 2 (Cardiology), University Hospital Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Schuhbaeck
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Internal Medicine 2 (Cardiology), University Hospital Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
authors.forename: Michaela M
authors.initials: MM
authors.lastname: Hell
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Internal Medicine 2 (Cardiology), University Hospital Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Muschiol
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Internal Medicine 2 (Cardiology), University Hospital Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
authors.forename: Soeren
authors.initials: S
authors.lastname: Gauss
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Radiology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lell
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Radiology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Internal Medicine 2 (Cardiology), University Hospital Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Internal Medicine 2 (Cardiology), University Hospital Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Marwan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000601:surgery*; D000072226:Computed Tomography Angiography; D003287:Contrast Media / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic; D008297:Male; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Aortography; Computed tomography; Heart valve prosthesis implantation; Low contrast agent; Transcatheter aortic valve implantation (TAVI)