Low contrast media volume in pre-TAVI CT examinations

Madeleine Kok, Jakub Turek, Casper Mihl, Sebastian D Reinartz, Robin F Gohmann, Estelle C Nijssen, Suzanne Kats, Vincent G van Ommen, Bas L J H Kietselaer, Joachim E Wildberger, Marco Das, Madeleine Kok, Jakub Turek, Casper Mihl, Sebastian D Reinartz, Robin F Gohmann, Estelle C Nijssen, Suzanne Kats, Vincent G van Ommen, Bas L J H Kietselaer, Joachim E Wildberger, Marco Das

Abstract

Purpose: To evaluate image quality using reduced contrast media (CM) volume in pre-TAVI assessment.

Methods: Forty-seven consecutive patients referred for pre-TAVI examination were evaluated. Patients were divided into two groups: group 1 BMI < 28 kg/m(2) (n = 29); and group 2 BMI > 28 kg/m(2) (n = 18). Patients received a combined scan protocol: retrospective ECG-gated helical CTA of the aortic root (80kVp) followed by a high-pitch spiral CTA (group 1: 70 kV; group 2: 80 kVp) from aortic arch to femoral arteries. All patients received one bolus of CM (300 mgI/ml): group 1: volume = 40 ml; flow rate = 3 ml/s, group 2: volume = 53 ml; flow rate = 4 ml/s. Attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the levels of the aortic root (helical) and peripheral arteries (high-pitch). Diagnostic image quality was considered sufficient at attenuation values > 250HU and CNR > 10.

Results: Diagnostic image quality for TAVI measurements was obtained in 46 patients. Mean attenuation values and CNR (HU ± SD) at the aortic root (helical) were: group 1: 381 ± 65HU and 13 ± 8; group 2: 442 ± 68HU and 10 ± 5. At the peripheral arteries (high-pitch), mean values were: group 1: 430 ± 117HU and 11 ± 6; group 2: 389 ± 102HU and 13 ± 6.

Conclusion: CM volume can be substantially reduced using low kVp protocols, while maintaining sufficient image quality for the evaluation of aortic root and peripheral access sites.

Key points: • Image quality could be maintained using low kVp scan protocols. • Low kVp protocols reduce contrast media volume by 34-67 %. • Less contrast media volume lowers the risk of contrast-induced nephropathy.

Keywords: Contrast induced nephropathy; Contrast media; Diagnostic imaging; Multi detector-row CT; Transcatheter aortic valve implantation.

Figures

Fig. 1
Fig. 1
This figure shows the scout view with the planned anatomical range. The box with the dashed lines (1) indicates the retrospective ECG-gated acquisition of the heart in caudo-cranial direction. Box 2 indicates the high-pitch acquisition from the aortic arch to the femoral arteries in cranio-caudal direction
Fig. 2
Fig. 2
Images show the iliofemoral arteries obtained by the 80 kVp (left) and the 70 kVp (right) high-pitch CTA
Fig. 3
Fig. 3
Box plots showing attenuation levels of each vascular segment. ‘’AA helical” (black) was measured in the helical cardiac scan. ‘’AA high-pitch” and the other levels (white) were measured in the high-pitch spiral scan of the aorta. * AA = ascending aorta; DA = descending aorta; AAo = abdominal aorta; RCIA and LCIA = right and left common femoral artery; RCFA and LCLA = right and left common femoral artery
Fig. 4
Fig. 4
Box plots show SNR (left) and CNR (right) levels of each vascular segment. ’AA helical” (black) was measured in the helical cardiac scan. ‘’AA high-pitch” and the other levels (white) were measured in the high-pitch spiral scan of the aorta. * AA = ascending aorta; DA = descending aorta; AAo = abdominal aorta; RCIA and LCIA = right and left common femoral artery; RCFA and LCLA = right and left common femoral artery
Fig. 5
Fig. 5
Images show the difference in the dimensions of the annulus and valve between reconstruction at the 20 % phase of the cardiac cycle using retrospective ECG-gated helical acquisition (upper) and reconstruction using the non ECG-gated high-pitch acquisition (bottom). The measurements for short and long diameter as well as perimeter were: 21 mm, 25 mm and 4.2 cm2, respectively for the helical acquisition and 19 mm, 24 mm and 3.8 cm2, respectively for the high-pitch acquisition
Fig. 6
Fig. 6
This schematic figure shows the time to peak at the level of the ascending aorta as well as at the level of the peripheral arteries. The time in between was 12 s. Using the combined scan protocol, the fast second scan acquisition will again catch the bolus in the peripheral arteries. With only the retrospective ECG-gated acquisition scan time will be extended and the bolus will likely overtake the scan. A retrospective ECG-gated helical acquisition of the heart B gap between acquisitions C high-pitch acquisition of the aorta from aortic arch to femoral arteries

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