Clinical validation of dual-source dual-energy computed tomography (DECT) for coronary and valve imaging in patients undergoing trans-catheter aortic valve implantation (TAVI)

Mahoney, Rachel; Pavitt, Christopher; Gordon, Daniel; Park, B.; Rubens, Michael B.; Nicol, Edward; Padley, Simon

doi:10.1016/j.crad.2014.03.010

Cited by 16 publications

(11 citation statements)

References 23 publications

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“…2 Correlation between calcium scoring using true and virtual non-contrast images. RCACS, calcium scoring using true non-contrast images; VCACS, calcium scoring using virtual non-contrast images patients were classified in the same category comparing CACS calculated from TNC and VNC [8,9,19,20].…”

Section: Discussionmentioning

confidence: 99%

Calcium scoring using virtual non-contrast images from a dual-layer spectral detector CT: comparison to true non-contrast data and evaluation of proportionality factor in a large patient collective

et al. 2021

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Objective Determination of coronary artery calcium scoring (CACS) in non-contrast computed tomography (CT) images has been shown to be an important prognostic factor in coronary artery disease (CAD). The objective of this study was to evaluate the accuracy of CACS from virtual non-contrast (VNC) imaging generated from spectral data in comparison to standard (true) non-contrast (TNC) imaging in a representative patient cohort with clinically approved software. Methods One hundred three patients referred to coronary CTA with suspicion of CAD were investigated on a dual-layer spectral detector CT (SDCT) scanner. CACS was calculated from both TNC and VNC images by software certified for medical use. Patients with a CACS of 0 were excluded from analysis. Results The mean age of the study population was 61 ± 11 years with 48 male patients (67%). Inter-quartile range of clinical CACS was 22–282. Correlation of measured CACS from true- and VNC images was high (0.95); p < 0.001. The slope was 3.83, indicating an underestimation of VNC CACS compared to TNC CACS by that factor. Visual analysis of the Bland-Altman plot of CACS showed good accordance with both methods after correction of VNC CACS by the abovementioned factor. Conclusions In clinical diagnostics of CAD, the determination of CACS is feasible using VNC images generated from spectral data obtained on a dual-layer spectral detector CT. When multiplied by a correction factor, results were in good agreement with the standard technique. This could enable radiation dose reductions by obviating the need for native scans typically used for CACS. Key Points • Calcium scoring is feasible from contrast-enhanced CT images using a dual-layer spectral detector CT scanner. • When multiplied by a correction factor, calcium scoring from virtual non-contrast images shows good agreement with the standard technique. • Omitting native scans for calcium scoring could enable radiation dose reduction.

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Section: Discussionmentioning

confidence: 99%

Calcium scoring using virtual non-contrast images from a dual-layer spectral detector CT: comparison to true non-contrast data and evaluation of proportionality factor in a large patient collective

et al. 2021

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“…Publication is designed to ensure we make our findings available to the whole CCT community. The departmental audit programme has led to publications in the areas of dual-energy CT, 33 the optimal use of high-pitch acquisition, 25 the effect of incidental findings in CT on outcome, 34 imaging optimisation in atrial fibrillation, 35 calcium scoring from CTCA datasets, 36,37 and high versus standard pitch acquisition in clinical practice. 38 In addition to sharing our findings we have achieved both wider benefit to the trainee in publishing but also a deeper cultural understanding of how audit, over time and following multiple cycles, clearly can deliver real-world improvement and prove a valuable tool in supporting a QA culture.…”

Section: Referral Reporting and Reviewmentioning

confidence: 99%

Quality assurance in cardiovascular CT: a practical guide

et al. 2016

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Cardiovascular computed tomography (CCT) is a cutting-edge imaging technique providing important, non-invasive, diagnostic information. Concerns exist regarding radiation exposure to patient populations, but achieving optimal image quality at the lowest doses can be challenging. This guide provides practical advice about how quality can be assured in any CCT unit or radiology department. Illustrated by real-world vignettes and data analysis from our own experience, we highlight a multidisciplinary team approach to each stage of the patient journey, the effectiveness of regular dose audit overseen by a CT optimisation group, and the importance of underused systolic scanning techniques, in order to drive significant dose reduction without loss of image quality or clinical confidence.

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“…The radiation dose for each study was calculated as the total dose-length product (DLP, mGy cm) as previously described, 12 together with the volume CT dose index (CTDI vol ) for the whole-body angiogram. Effective dose for a standard-sized patient was estimated using the ImPACT dose calculator in accordance with International Committee on Radiation Protection (ICRP) 60.…”

Section: Methodsmentioning

confidence: 99%

High-pitch versus conventional cardiovascular CT in patients being assessed for transcatheter aortic valve implantation: a real-world appraisal

et al. 2017

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ObjectiveHigh-pitch protocols are increasingly used in cardiovascular CT assessment for transcatheter aortic valve implantation (TAVI), but the impact on diagnostic image quality is not known.MethodsWe reviewed 95 consecutive TAVI studies: 44 (46%) high-pitch and 51 (54%) standard-pitch. Single high-pitch scans were performed regardless of heart rate. For standard-pitch acquisitions, a separate CT-aortogram and CT-coronary angiogram were performed with prospective gating, unless heart rate was ≥70 beats/min, when retrospective gating was used. The aortic root and coronary arteries were assessed for artefact (significant artefact=1; artefact not limiting diagnosis=2; no artefact=3). Aortic scans were considered diagnostic if the score was >1; the coronaries, if all three epicardial arteries scored >1.ResultsThere was no significant difference in diagnostic image quality for either the aorta (artefact-free high-pitch: 31 (73%) scans vs standard-pitch: 40 (79%), p=0.340) or the coronary tree as a whole (10 (23%) vs 15 (29%), p=0.493). However, proximal coronary arteries were less well visualised using high-pitch acquisitions (16 (36%) vs 30 (59%), p=0.04). The median (IQR) radiation dose was significantly lower in the high-pitch cohort (dose-length product: 347 (318–476) vs 1227 (1150–1474) mGy cm, respectively, p<0.001), and the protocol required almost half the amount of contrast.ConclusionsThe high-pitch protocol significantly reduces radiation and contrast doses and is non-inferior to standard-pitch acquisitions for aortic assessment. For aortic root assessment, the high-pitch protocol is recommended. However, if coronary assessment is critical, this should be followed by a conventional standard-pitch, low-dose, prospectively gated CT-coronary angiogram if the high-pitch scan is non-diagnostic.

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Clinical validation of dual-source dual-energy computed tomography (DECT) for coronary and valve imaging in patients undergoing trans-catheter aortic valve implantation (TAVI)

Cited by 16 publications

References 23 publications

Calcium scoring using virtual non-contrast images from a dual-layer spectral detector CT: comparison to true non-contrast data and evaluation of proportionality factor in a large patient collective

Calcium scoring using virtual non-contrast images from a dual-layer spectral detector CT: comparison to true non-contrast data and evaluation of proportionality factor in a large patient collective

Quality assurance in cardiovascular CT: a practical guide

High-pitch versus conventional cardiovascular CT in patients being assessed for transcatheter aortic valve implantation: a real-world appraisal

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