Computer-aided evaluation of low-dose and low-contrast agent third-generation dual-source CT angiography prior to transcatheter aortic valve implantation (TAVI)

Dankerl P, Hammon M, Seuß H, Tröbs M, Schuhbaeck A, Hell MM, Achenbach S, Uder M, Marwan M, Cavallaro AJ (2016)

Publication Type: Journal article

Publication year: 2016

Journal

International Journal of Computer Assisted Radiology and Surgery Springer Verlag (Germany)

Abstract

To evaluate the performance of computer-aided evaluation software for a comprehensive workup of patients prior to transcatheter aortic valve implantation (TAVI) using low-contrast agent and low radiation dose third-generation dual-source CT angiography.We evaluated 30 consecutive patients scheduled for TAVI. All patients underwent ECG-triggered high-pitch dual-source CT angiography of the aortic root and aorta with a standardized contrast agent volume (30 ml Imeron350, flow rate 4 ml/s) and low-dose (100 kv/350 mAs) protocol. An expert (10 years of experience) manually evaluated aortic root and iliac access dimensions (distance between coronary ostia and aortic annulus, minimal/maximal diameters and area-derived diameter of the aortic annulus) and best CT-predicted fluoroscopic projection angle as the reference standard. Utilizing computer-aided software (syngo.via), the same pre-TAVI workup was performed and compared to the reference standard.Mean CTDI[Formula: see text] was 3.46 mGy and mean DLP 217.6 ± 12.1 mGy cm, corresponding to a mean effective dose of 3.7 ± 0.2 mSv. Computer-aided evaluation was successful in all but one patient. Compared to the reference standard, Bland-Altman analysis indicated very good agreement for the distances between aortic annulus and coronary ostia (RCA: mean difference 0.8 mm; 95 % CI 0.4-1.2 mm; LM: mean difference 0.9 mm; 95 % CI 0.5-1.3 mm); however, we demonstrated a systematic overestimation of annulus- derived diameter using the software (mean difference 44.4 mm[Formula: see text]; 95 % CI 30.4-58.3 mm[Formula: see text]). Based on respective annulus dimensions, the recommended prosthesis size (Edwards SAPIEN 3) matched in 26 out of the 29 patients (90 %). CT-derived fluoroscopic projection angles showed an excellent agreement for both methods. Out of 58 iliac arteries, 15 (25 %) arteries could not be segmented by the software. Preprocessing time of the software was 71 ± 11 s (range 51-96 s), and reading time with the software was 118 ± 31 s (range 68-201 s).In the workup of pre-TAVI CT angiography, computer-aided evaluation of low-contrast, low-dose examinations is feasible with good agreement and quick reading time. However, a systematic overestimation of the aortic annulus area is observed.

Authors with CRIS profile

Peter Dankerl Lehrstuhl für Diagnostische Radiologie Matthias Hammon Institute of Radiology Hannes Seuß Professur für Plastische Chirurgie und Handchirurgie Monique Tröbs Department of Medicine 2 – Cardiology and Angiology Stephan Achenbach Department of Medicine 2 – Cardiology and Angiology Michael Uder Lehrstuhl für Diagnostische Radiologie Mohamed Marwan Department of Medicine 2 – Cardiology and Angiology Alexander Josef Cavallaro Institute of Radiology

How to cite

APA:

Dankerl, P., Hammon, M., Seuß, H., Tröbs, M., Schuhbaeck, A., Hell, M.M.,... Cavallaro, A.J. (2016). Computer-aided evaluation of low-dose and low-contrast agent third-generation dual-source CT angiography prior to transcatheter aortic valve implantation (TAVI). International Journal of Computer Assisted Radiology and Surgery. https://dx.doi.org/10.1007/s11548-016-1470-8

MLA:

Dankerl, Peter, et al. "Computer-aided evaluation of low-dose and low-contrast agent third-generation dual-source CT angiography prior to transcatheter aortic valve implantation (TAVI)." International Journal of Computer Assisted Radiology and Surgery (2016).

BibTeX: Download