title: Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning.
abstract: OBJECTIVE
  To investigate feasibility, image quality and safety of low-tube-voltage, low-contrast-volume comprehensive cardiac and aortoiliac CT angiography (CTA) for planning transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  Forty consecutive TAVR candidates prospectively underwent combined CTA of the aortic root and vascular access route (270 mgI/ml iodixanol). Patients were assigned to group A (second-generation dual-source CT [DSCT], 100 kV, 60 ml contrast, 4.0 ml/s flow rate) or group B (third-generation DSCT, 70 kV, 40 ml contrast, 2.5 ml/s flow rate). Vascular attenuation, noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were compared. Subjective image quality was assessed by two observers. Estimated glomerular filtration (eGFR) at CTA and follow-up were measured.
  
  
  RESULTS
  Besides a higher body-mass-index in group B (24.8±3.8 kg/m2vs. 28.1±5.4 kg/m2, P=0.0339), patient characteristics between groups were similar (P≥0.0922). Aortoiliac SNR (P=0.0003) was higher in group B. Cardiac SNR (P=0.0003) and CNR (P=0.0181) were higher in group A. Subjective image quality was similar (P≥0.213) except for aortoiliac image noise (4.42 vs. 4.12, P=0.0374). TAVR-planning measurements were successfully obtained in all patients. There were no significant changes in eGFR among and between groups during follow-up (P≥0.302).
  
  
  CONCLUSIONS
  TAVR candidates can be safely and effectively evaluated by a comprehensive CTA protocol with low contrast volume using low-tube-voltage acquisition.
  
  
  CONCLUSIONS
  • Third-generation dual-source CT facilitates low-tube-voltage acquisition. • TAVR planning can be performed with reduced contrast volume and radiation dose. • TAVR-planning CT did not result in changes in creatinine levels at follow-up. • TAVR candidates can be safely evaluated by comprehensive low-tube-voltage CT angiography.
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.|Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Felmly
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. schoepf@musc.edu.|Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. schoepf@musc.edu.
authors.forename: U Joseph
authors.identifier: http://orcid.org/0000-0002-6164-5641
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Akos
authors.initials: A
authors.lastname: Varga-Szemes
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.|Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Mangold
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: McQuiston
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.|Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Sheldon E
authors.initials: SE
authors.lastname: Litwin
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.|Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Bayer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.|Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Julian L
authors.initials: JL
authors.lastname: Wichmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography / Q000379:methods*; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D011829:Radiation Dosage; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D014283:Triiodobenzoic Acids
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