Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

Low Contrast and Low kV CTA Before Transcatheter Aortic Valve Replacement: A Systematic Review

  • Spencer C. Lacy (Department of Internal Medicine, Loyola University Medical Center) ;
  • Mina M. Benjamin (Division of Cardiovascular Medicine, Loyola University Medical Center) ;
  • Mohammed Osman (Knight & Cardiovascular Institute, Oregon Health & Science University) ;
  • Mushabbar A. Syed (Division of Cardiovascular Medicine, Loyola University Medical Center) ;
  • Menhel Kinno (Division of Cardiovascular Medicine, Loyola University Medical Center)
  • Received : 2022.09.25
  • Accepted : 2023.01.03
  • Published : 2023.04.27
Download PDF
⟨ Previous Next ⟩

Abstract

BACKGROUND: Minimizing contrast dose and radiation exposure while maintaining image quality during computed tomography angiography (CTA) for transcatheter aortic valve replacement (TAVR) is desirable, but not well established. This systematic review compares image quality for low contrast and low kV CTA versus conventional CTA in patients with aortic stenosis undergoing TAVR planning. METHODS: We performed a systematic literature review to identify clinical studies comparing imaging strategies for patients with aortic stenosis undergoing TAVR planning. The primary outcomes of image quality as assessed by the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were reported as random effects mean difference with 95% confidence interval (CI). RESULTS: We included 6 studies reporting on 353 patients. There was no difference in cardiac SNR (mean difference, -1.42; 95% CI, -5.71 to 2.88; p = 0.52), cardiac CNR (mean difference, -3.83; 95% CI, -9.98 to 2.32; p = 0.22), aortic SNR (mean difference, -0.23; 95% CI, -7.83 to 7.37; p = 0.95), aortic CNR (mean difference, -3.95; 95% CI, -12.03 to 4.13; p = 0.34), and ileofemoral SNR (mean difference, -6.09; 95% CI, -13.80 to 1.62; p = 0.12) between the low dose and conventional protocols. There was a difference in ileofemoral CNR between the low dose and conventional protocols with a mean difference of -9.26 (95% CI, -15.06 to -3.46; p = 0.002). Overall, subjective image quality was similar between the 2 protocols. CONCLUSIONS: This systematic review suggests that low contrast and low kV CTA for TAVR planning provides similar image quality to conventional CTA.

Keywords

References

  1. Slomski A. TAVR vs surgery in low-risk patients. JAMA 2019;321:1965.
  2. Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr 2012;6:366-80.
  3. Holmes DR Jr, Mack MJ, Kaul S, et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012;59:1200-54.
  4. Faggiano P, Frattini S, Zilioli V, et al. Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process. Int J Cardiol 2012;159:94-9.
  5. Bagur R, Webb JG, Nietlispach F, et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 2010;31:865-74.
  6. Azzalini L, Abbara S, Ghoshhajra BB. Ultra-low contrast computed tomographic angiography (CTA) with 20-mL total dose for transcatheter aortic valve implantation (TAVI) planning. J Comput Assist Tomogr 2014;38:105-9.
  7. Meyer M, Haubenreisser H, Schoepf UJ, et al. Closing in on the K edge: coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 2014;273:373-82.
  8. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71.
  9. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343 oct18 2:d5928.
  10. Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919.
  11. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88.
  12. Felmly LM, De Cecco CN, Schoepf UJ, et al. Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning. Eur Radiol 2017;27:1944-53.
  13. Talei Franzesi CR, Ippolito D, Riva L, Fior D, Cangiotti C, Sironi S. Diagnostic value of iterative reconstruction algorithm in low kV CT angiography (CTA) with low contrast medium volume for transcatheter aortic valve implantation (TAVI) planning: image quality and radiation dose exposure. Br J Radiol 2018;91:20170802.
  14. Hachulla AL, Noble S, Ronot M, et al. Low iodine contrast injection for CT acquisition prior to transcatheter aortic valve replacement: aorta assessment and screening for coronary artery disease. Acad Radiol 2019;26:e150-60.
  15. Onoda H, Ueno H, Hashimoto M, Kuwahara H, Sobajima M, Kinugawa K. Clinical advantages of using low tube voltage in third-generation 192-slice dual-source computed tomographic angiography before transcatheter aortic valve implantation. Int Heart J 2019;60:1091-7.
  16. Ippolito D, Riva L, Talei Franzesi C, et al. Computed tomography angiography combined with knowledge-based iterative algorithm for transcatheter aortic valve implantation planning: image quality and radiation dose exposure with low-kV and low-contrast-medium protocol. J Comput Assist Tomogr 2020;44:13-9.
  17. Sucha D, Kino A, Bogart K, et al. Effect of low contrast medium-dose CTA on device sizing and access vessel assessment for TAVR. Eur J Radiol 2020;124:108826.
  18. Zemedkun M, LaBounty TM, Bergman G, et al. Effectiveness of a low contrast load CT angiography protocol in octogenarians and nonagenarians being evaluated for transcatheter aortic valve replacement. Clin Imaging 2015;39:815-9.
  19. Truong VT, Choo J, McCoy L, et al. Low-volume contrast CT angiography via pulmonary artery injection for measurement of aortic annulus in patients undergoing transcatheter aortic valve replacement. J Invasive Cardiol 2017;29:181-6.
  20. McCollough CH, Leng S, Yu L, Fletcher JG. Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology 2015;276:637-53.
  21. Patino M, Prochowski A, Agrawal MD, et al. Material separation using dual-energy CT: current and emerging applications. Radiographics 2016;36:1087-105.
  22. Zopfs D, Lennartz S, Laukamp K, et al. Improved depiction of atherosclerotic carotid artery stenosis in virtual monoenergetic reconstructions of venous phase dual-layer computed tomography in comparison to polyenergetic reconstructions. Eur J Radiol 2018;100:36-42.
  23. Vlahos I, Godoy MC, Naidich DP. Dual-energy computed tomography imaging of the aorta. J Thorac Imaging 2010;25:289-300.
  24. Cavallo AU, Patterson AJ, Thomas R, et al. Low dose contrast CT for transcatheter aortic valve replacement assessment: results from the prospective SPECTACULAR study (spectral CT assessment prior to TAVR). J Cardiovasc Comput Tomogr 2020;14:68-74.
  25. Mangold D, Salatzki J, Riffel J, Kauczor HU, Weber TF. Dual-layer spectral CTA for TAVI planning using a split-phase protocol and low-keV virtual monoenergetic images: improved image quality in comparison with single-phase conventional CTA. RoFo Fortschr Geb Rontgenstr Nuklearmed 2021;2021: ; E-pub ahead of print.
  26. Bittner DO, Arnold M, Klinghammer L, et al. Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior to transcatheter aortic valve implantation. Eur Radiol 2016;26:4497-504.
  27. Kok M, Turek J, Mihl C, et al. Low contrast media volume in pre-TAVI CT examinations. Eur Radiol 2016;26:2426-35.
  28. 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 2017;12:795-802.
  29. Blanke P, Weir-McCall JR, Achenbach S, et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): an expert consensus document of the society of cardiovascular computed tomography. JACC Cardiovasc Imaging 2019;12:1-24.
  30. Toprak O. Conflicting and new risk factors for contrast induced nephropathy. J Urol 2007;178:2277-83.