Using DynaCT for the assessment of ilio-femoral arterial calibre, calcification and tortuosity index in patients selected for trans-catheter aortic valve replacement
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Adequate vascular access for femoral trans-catheter aortic valve replacement is fundamental to the success of the procedure. Assessment of vascular calibre, tortuosity and calcification is performed by angiography and multi-slice computed tomography (MSCT). Can DynaCT provide the same information as MSCT? 15 Patients underwent MSCT, angiography and DynaCT. Vessel diameter measurements were taken in three positions of the left and right ilio-femoral arteries. Tortuosity was assessed using an index of the direct distance and the distance taken by the artery between two points. Calcification was assessed in MSCT and DynaCT using a simple scoring system. Concordance correlation coefficient of arterial calibre between angiography and MSCT was 0.96 (95 % CI 0.94–0.97). DynaCT and angiography was 0.94 (95 % CI 0.91–0.96) and Dyna CT and MSCT, 0.95 (95 % CI 0.92–0.97). Bland–Altman tests demonstrate a mean difference between the angiogram and the MSCT of 0.06 mm (+0.97, −1.42), angiogram and DynaCT, 0.13 mm, (+1.00, −0.87), DynaCT and MSCT, 0.2 mm, (+1.15, −0.76). Tortuosity comparisons gave a median tortuosity index for MSCT 1.29 and DynaCT 1.23 (p = 0.472). Calcification comparisons of MSCT and DynaCT using correlation coefficients demonstrate a correlation of 0.245 (p = 0.378). Effective radiation doses were: DynaCT; 3.63 ± 0.65 mSv and angiography; 0.57 ± 0.72 mSv, MSCT; 7.15 ± 2.58 mSv. DynaCT is equal to MSCT and angiography in assessing femoral artery calibre. Like MSCT, it can assess tortuosity and can produce 3D images but is inferior in the assessment of calcification.
KeywordsDynaCT TAVR Vessel calibre Tortuosity Calcification
JinLin Fu (MBBS PHD) for his work in providing statistical analysis for this paper.
Conflict of interest
The Prince Charles Hospital is involved in a research collaboration with Siemens Healthcare. Dr. Darren Walters is a consultant for Siemens, Medtronic Inc., a Proctor for Edwards Lifesciences and principal investigator for SOURCE ANZ registry. There are no other stock ownership, or other equity interests or patent-licensing arrangements within the article.
- 3.Poon KK, Crowhurst J, James C, Campbell D, Roper D, Chan J, Incani A, Clarke A, Tesar P, Aroney C, Raffel OC, Walters DL (2012) Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements—utility of three-dimensional rotational angiography. EuroIntervention 8(5):538–545PubMedCrossRefGoogle Scholar
- 5.ICRP (2007) Managing patient dose in multi-detector computed tomography (MDCT). ICRP Publication 102. Ann ICRP 37(1)Google Scholar
- 6.Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, Eggebrecht H et al (2010) Thirty-day results of the SAPIEN aortic bioprosthesis European outcome (SOURCE) registry: a European registry of transcatheter aortic valve implantation using the edwards SAPIEN valve. Circulation 122:62–69PubMedCrossRefGoogle Scholar
- 14.Onuma Y, Tanabe K, Nakazawa G, Aoki J, Nakajima H, Ibukuro K et al (2006) Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol 18:415Google Scholar