Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning

Felmly, Lloyd M.; Cecco, Carlo N. De; Schoepf, U. Joseph; Varga-Szemes, Ákos; Mangold, Stefanie; McQuiston, Andrew D.; Litwin, Sheldon E.; Bayer, Richard R.; Vogl, Thomas J.; Wichmann, Julian L.

doi:10.1007/s00330-016-4537-6

Cited by 37 publications

(22 citation statements)

References 32 publications

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“…In discordant scores, a consensus reading was performed between the two observers. The IQ of the attenuation of the coronary was assessed with a 5-point Likert scale as follows: score of 1, insufficient attenuation resulting in a non-diagnostic examination; 2, poor, suboptimal attenuation with low diagnostic confidence; 3, fair, acceptable attenuation of relevant cardiac anatomy and vascular access; 4, good, satisfactory attenuation providing sufficient evaluation of relevant anatomy; 5, excellent, strong attenuation of even the smallest arteries [9]. The presence and extent of image artifact was assessed with the 5-point Likert scale as follows: score of 1, non-diagnostic, severe artifact; 2, poor, substantial artifact but sufficient contrast attenuation for assessing the heart system; 3, fair, moderate artifact not interfering with a comprehensive examination of the coronary artery; 4, good, with only minor artifact not interfering with assessment; 5, excellent, with no artifact or any diagnostic limitation [9].…”

Section: Qualitative Image Assessmentmentioning

confidence: 99%

Comparing feasibility of low-tube-voltage protocol with low-iodine-concentration contrast and high-tube-voltage protocol with high-iodine-concentration contrast in coronary computed tomography angiography

et al. 2020

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Background To investigate the feasibility of a low tube voltage (80 kVp) protocol with low concentration contrast media (CM) (iodixanol 320 mgl/ml) as compared with a high tube voltage (100 kVp) protocol with high concentration CM (iomeprol 400 mgl/ml) in coronary CT angiography (CCTA) for patients with body mass index less than 30. Materials and methods A total of 93 patients were randomly assigned into three groups and underwent CCTA as follows: Group A) 100 kVp, 100-350 mAs, 400 mgl/ml CM at 4ml/s, and reconstructed with filtered back projection; Group B and C) 80 kVp, 100-450 mAs, 320 mgl/ml CM at 4 ml/s and 5 ml/s, respectively and reconstructed with iterative reconstruction. Objective and subjective image quality (IQ) was analyzed. Results The image noise, intravascular attenuation, signal-to-noise ratio and contrast-to-noise ratio of major coronary arteries did not differ significantly among three groups. Subjective IQ analyses on vascular attenuation and image noise did not differ significantly, either (all of p > 0.05). Qualitative IQ of Group B and C was non-inferior to that of Group A. Substantial reduction of radiation exposure was achieved in group B (2.60 ± 0.48 mSv) and C (2.72 ± 0.54 mSv), compared with group A (3.58 ± 0.67 mSv) (p < 0.05).

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Section: Qualitative Image Assessmentmentioning

confidence: 99%

Comparing feasibility of low-tube-voltage protocol with low-iodine-concentration contrast and high-tube-voltage protocol with high-iodine-concentration contrast in coronary computed tomography angiography

et al. 2020

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“…Bitter, et al 20) used 38 mL CM using a third-generation DSCT system, allowing comprehensive imaging for procedural success. Felmy, et al 21) investigated the scope for reducing the CM dose in CTA for TAVI screening, and compared CTA using a thirdgeneration DSCT system (70 kV, 40 mL CM) with CTA using a second-generation DSCT system (100 kV, 60 mL CM). However, there was no report comparing low tube voltage and conventional tube voltage using thirdgeneration DSCT in patients for TAVI.…”

Section: Discussionmentioning

confidence: 99%

Clinical Advantages of Using Low Tube Voltage in Third-Generation 192-Slice Dual-Source Computed Tomographic Angiography Before Transcatheter Aortic Valve Implantation

et al. 2019

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Low-voltage computed tomographic angiography (CTA) is a highly effective technique to reduce contrast media volume. We sought to examine the suitability of low tube voltage CTA with a reduced contrast media volume protocol using third-generation 192-slice dual-source CT in patients undergoing transcatheter aortic valve implantation (TAVI). CTA was performed to aid TAVI planning for 40 consecutive patients with severe aortic stenosis. For the first 10 patients (120/100 kV group), we used a conventional tube voltage combined CTA protocol (an ECG-gated helical scan; 120 kV, non-gated helical scan; 100 kV). For the subsequent 30 patients (70-kV group), we adopted a low tube voltage CTA protocol. We evaluated vascular attenuation, image noise, contrast-to-noise ratio (CNR), and renal function. The mean contrast media (CM) volume was 77.7 ± 17.7 mL in the 120/100-kV group and 30.9 ± 6.3 mL in the 70-kV group (P < 0.001). In the images of the aortic valve complex, the mean attenuation was not significant difference for both groups. In the images of the aorto-femoral arteries, mean attenuation was > 250 Hounsfield Units and CNR was > 10 in all vascular segments for both groups. There was no significant difference in the change of renal function in the 70-kV group, but renal function in the 120/100-kV group decreased within 1-3 months after CTA. Low tube voltage CTA using third-generation dual-source CT is suitable to assess procedural planning for TAVI. This approach maintains image quality and reduces the required CM volume.

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“…In a recently published study by Kim et al, CM volume usage in coronary CTA performed with 320-row CT could be decreased from 60 to 40 ml with preserved image quality and diagnostic accuracy [ 16 ]. In addition, Felmly et al demonstrated that with the latest generation dual source CT a comprehensive transcatheter aortic valve replacement planning was feasible with reduced CM volumes [ 17 ]. In line with these findings, Mangold et al demonstrated that the use of automated tube voltage selection and CM volume adjustment reduces CM volumes and provides excellent image quality and optimal intravascular attenuation [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial

et al. 2017

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ObjectivesContrast media (CM) extravasation is a well-known complication of CT angiography (CTA). Our prospective randomized control study aimed to assess whether a four-phasic CM administration protocol reduces the risk of extravasation compared to the routinely used three-phasic protocol in coronary CTA.MethodsPatients referred to coronary CTA due to suspected coronary artery disease were included in the study. All patients received 400 mg/ml iomeprol CM injected with dual-syringe automated injector. Patients were randomized into a three-phasic injection-protocol group, with a CM bolus of 85 ml followed by 40 ml of 75%:25% saline/CM mixture and 30 ml saline chaser bolus; and a four-phasic injection-protocol group, with a saline pacer bolus of 10 ml injected at a lower flow rate before the three-phasic protocol.Results2,445 consecutive patients were enrolled (mean age 60.6 ± 12.1 years; females 43.6%). Overall rate of extravasation was 0.9% (23/2,445): 1.4% (17/1,229) in the three-phasic group and 0.5% (6/1,216) in the four-phasic group (p = 0.034).ConclusionsFour-phasic CM administration protocol is easy to implement in the clinical routine at no extra cost. The extravasation rate is reduced by 65% with the application of the four-phasic protocol compared to the three-phasic protocol in coronary CTA.Key Points • Four-phasic CM injection-protocol reduces extravasation rate by 65% compared to three-phasic. • The saline pacer bolus substantially reduces the risk of CM extravasation. • The implementation of four-phasic injection-protocol is at no cost.

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Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning

Cited by 37 publications

References 32 publications

Comparing feasibility of low-tube-voltage protocol with low-iodine-concentration contrast and high-tube-voltage protocol with high-iodine-concentration contrast in coronary computed tomography angiography

Comparing feasibility of low-tube-voltage protocol with low-iodine-concentration contrast and high-tube-voltage protocol with high-iodine-concentration contrast in coronary computed tomography angiography

Clinical Advantages of Using Low Tube Voltage in Third-Generation 192-Slice Dual-Source Computed Tomographic Angiography Before Transcatheter Aortic Valve Implantation

The effect of four-phasic versus three-phasic contrast media injection protocols on extravasation rate in coronary CT angiography: a randomized controlled trial

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