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Published on: September 22, 2023
Estimation of Aortic Valve Calcium Score Based on Angiographic Phase Versus Reduction of Ionizing Radiation Dose in
Paweł Gać1,2, Bartłomiej Kędzierski3, Piotr Macek4
1Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland.
Insights
Estimating aortic valve calcium score (AVCS) using only the angiographic phase of multislice computed tomography (MSCT) is effective. This method significantly reduces radiation dose during MSCT examinations before transcatheter aortic valve implantation (TAVI).
Area of Science:
- Radiology
- Cardiovascular Imaging
- Medical Physics
Background:
- Aortic valve calcium score (AVCS) is crucial for assessing aortic stenosis severity.
- Multislice computed tomography (MSCT) is commonly used for AVCS estimation.
- Reducing radiation exposure in medical imaging is a significant concern.
Purpose of the Study:
- To evaluate the efficacy of estimating AVCS using the angiographic phase of MSCT.
- To determine the potential reduction in ionizing radiation dose achievable with this method.
- To develop mathematical models for estimating native AVCS from angiographic phase data.
Main Methods:
- Fifty-one patients undergoing transcatheter aortic valve implantation (TAVI) were included.
- MSCT was performed in both native and angiographic phases.
- AVCS was calculated from native phase reconstructions (3.0 mm and 2.0 mm slices) and angiographic phase reconstructions (0.6 mm slices) with varying HU thresholds (500 HU and 600 HU).
- Mathematical formulas were derived to correlate AVCS values from both phases.
Main Results:
- Mathematical formulations were established to estimate native AVCS from angiographic phase AVCS.
- A potential dose length product (DLP) reduction of 4.45 ± 1.54% was observed.
- The study demonstrated that AVCS can be reliably estimated using only the angiographic phase of MSCT.
Conclusions:
- Estimating AVCS solely from the angiographic phase of MSCT is feasible and accurate.
- This approach allows for a significant reduction in radiation dose during MSCT examinations prior to TAVI.
- The findings support optimizing MSCT protocols to minimize patient radiation exposure while maintaining diagnostic quality.
Abstract:
The aim of the study was to evaluate the estimation efficacy of aortic valve calcium score (AVCS) based on the multislice computed tomography (MSCT) angiographic phase. The evaluation of the reduced amount of ionizing radiation dose was performed because of this estimation. The study included 51 consecutive patients who qualified for transcatheter aortic valve implantation (TAVI) (78.59 ± 5.72 years). All subjects underwent MSCT: in the native phase dedicated to AVCS as well as angiographic phases aimed to morphologically assess the aortic ostium and arterial accesses for TAVI. Based on the native phase, an AVCS assessment was performed for axial reconstructions at 3.0 mm and 2.0 mm slice thickness (AVCSnative3.0 and AVCSnative2.0). Based on the angiographic phase AVCS was estimated for axial reconstruction at 0.6 mm slice thickness with increased values of lesion density in aortic valve cusps/aortic valve annulus, which is considered a calcification, from a typical value of 130 HU to 500 HU and 600 HU (AVCSCTA0.6 500 HU and AVCSCTA0.6 600 HU). Mathematical formulations were developed, allowing for AVCS native calculation based on AVCS values estimated based on the angiographic phase: AVCSnative3.0 = 813.920 + 1.510 AVCSCTA0.6 500 HU; AVCSnative3.0 = 1235.863 + 1.817 AVCSCTA0.6 600 HU; AVCSnative2.0 = 797.471 + 1.393 AVCSCTA0.6 500 HU; AVCSnative2.0 = 1228.310 + 1.650 AVCSCTA0.6 600 HU. The amount of a potential reduction in dose length product (DLP) in the case of AVCS estimation was 4.45 ± 1.54%. In summary, relying solely on the angiographic phase of MSCT examination before TAVI, it is possible to conclusively estimate AVCS. This estimation results in a marked reduction in radiation dose in MSCT.
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