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

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Abstract

Purpose

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.

Methods

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.

Results

Mean CTDI\(_\mathrm{vol}\) 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\(^{2}\); 95 % CI 30.4–58.3 mm\(^{2}\)). 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).

Conclusion

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.

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    Authors and Affiliations

    1. Department of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany

      Peter Dankerl, Matthias Hammon, Hannes Seuss, Alexander Cavallaro & Michael Uder

    2. Department of Cardiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany

      Monique Tröbs, Annika Schuhbaeck, Michaela M. Hell, Stephan Achenbach & Mohamed Marwan

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    1. Peter Dankerl
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    2. Matthias Hammon
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    3. Hannes Seuss
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    4. Monique Tröbs
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    5. Annika Schuhbaeck
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    6. Michaela M. Hell
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    7. Alexander Cavallaro
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    8. Stephan Achenbach
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    9. Michael Uder
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    Correspondence to Matthias Hammon.

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    Conflict of interest

    The authors declare that they have no conflicts of interest in the research. Mohamed Marwan received speaker Honoria from Edwards Lifesciences. Michael Uder received speaker Honoria from Bayer Healthcare and Siemens Healthcare. Alexander Cavallaro received speaker Honoria from Siemens Healthcare.

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    Peter Dankerl and Matthias Hammon have contributed equally to this work.

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    Dankerl, P., Hammon, M., Seuss, H. 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). Int J CARS 12, 795–802 (2017). https://doi.org/10.1007/s11548-016-1470-8

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    • DOI: https://doi.org/10.1007/s11548-016-1470-8

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