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Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior
Daniel O Bittner1,2, Martin Arnold3, Lutz Klinghammer3
1Friedrich-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.
Insights
Reduced contrast volume CT angiography is feasible for transcatheter aortic valve implantation (TAVI) planning in patients with chronic renal failure. This novel protocol ensures comprehensive imaging for successful TAVI procedures.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Nephrology
Background:
- Chronic renal failure is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI).
- CT angiography (CTA) is essential for pre-procedural assessment in TAVI.
- Optimizing contrast volume is critical for patients with renal impairment.
Purpose of the Study:
- To evaluate the feasibility of a reduced contrast volume protocol for pre-procedural CT imaging in TAVI candidates.
- To assess the diagnostic quality and safety of low-contrast CTA.
- To determine if reduced contrast volume impacts procedural planning and success.
Main Methods:
- Prospective study of 40 consecutive patients undergoing TAVI.
- Utilized a third-generation dual-source CT system with a high-pitch spiral acquisition.
- Administered a reduced contrast volume of 38 ml, assessing image quality and contrast attenuation.
Main Results:
- The low-contrast protocol (38 ml) provided adequate image quality for pre-procedural assessment.
- Mean contrast attenuation was comparable at the aortic annulus and iliac bifurcation.
- Mean estimated effective radiation dose was low (2.9 mSv), with only one repeat acquisition needed.
Conclusions:
- Pre-procedural CTA with 38 ml contrast is feasible and clinically valuable for TAVI planning.
- This reduced contrast protocol is safe and effective, particularly for patients with chronic renal failure.
- Novel CT technology enables comprehensive imaging with lower contrast volumes, facilitating successful TAVI outcomes.
Objectives:
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.
Conclusion:
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.
Key Points:
• 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.
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