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Updated: Mar 9, 2026
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
CT angiography for planning transcatheter aortic valve replacement using automated tube voltage selection: Image
Stefanie Mangold1, Carlo N De Cecco2, U Joseph Schoepf3
1Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany.
Purpose:
To assess image quality and accuracy of CT angiography (CTA) for transcatheter aortic valve replacement (TAVR) planning performed with 3rd generation dual-source CT (DSCT).
Material And Methods:
We evaluated 125 patients who underwent TAVR-planning CTA on 3rd generation DSCT. A two-part protocol was performed including retrospectively ECG-gated coronary CTA (CCTA) and prospectively ECG-triggered aortoiliac CTA using 60mL of contrast medium. Automated tube voltage selection and advanced iterative reconstruction were applied. Effective dose (ED), signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were calculated. Five-point scales were used for subjective image quality analysis. In patients who underwent TAVR, sizing parameters were obtained.
Results:
Image quality was rated good to excellent in 97.6% of CCTA and 100% of aortoiliac CTAs. CTA studies at >100kV showed decreased objective image quality compared to 70-100kV (SNR, all p≤0.0459; CNR, all p≤0.0462). Mean ED increased continuously from 70 to >100kV (CCTA: 4.5±1.7mSv-13.6±2.9mSv, all p≤0.0233; aortoiliac CTA: 2.4±0.9mSv-6.8±2.7mSv, all p≤0.0414). In 39 patients TAVR was performed and annulus diameter was within the recommended range in all patients. No severe cardiac or vascular complications were noted.
Conclusion:
3rd generation DSCT provides diagnostic image quality in TAVR-planning CTA and facilitates reliable assessment of TAVR device and delivery option while reducing radiation dose.
