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Komber HMEI, Neumann S, Paull J, Andrade MG, Lyen SM, Manghat NE, Hamilton MCK. A quality-improvement project to enhance systemic arterial contrast opacification in CT for trans-catheter aortic valve implantation. Clin Radiol 2022; 77:e697-e704. [PMID: 35717408 DOI: 10.1016/j.crad.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/03/2022]
Abstract
AIM To assess improvement in arterial opacification by optimising the contrast medium dosing protocol for computed tomography (CT) prior to trans-catheter aortic valve implantation (TAVI). MATERIALS AND METHODS A wide variation in arterial opacification was observed in the initial CT TAVI protocol (standard protocol). The practice was optimised by considering the time required for the examination and optimising contrast medium flux. This became the optimised protocol with a 30-second contrast medium bolus of iodine flux 15-19 mg iodine/kg body weight/second (mg/kg/s). Attenuation (mean HU) in (a) the ascending aorta (gated systolic acquisition) and (b) the ascending, descending thoracic (at carina), infra-renal abdominal aorta, and right common iliac artery (non-gated acquisition) was measured. Thirty-one sequential optimised examinations were compared to 31 prior standard protocol examinations. RESULTS There was no difference between the standard and optimised groups regarding age, sex, weight, body mass index (BMI), or voltage. The mean bolus durations were 24.9±4.4 seconds for the standard and 30±0.3 seconds for the optimised protocols (p<0.001). Although there was no difference in the attenuation in the gated ascending aorta (p>0.99), there was improvement at all other anatomical points in the non-gated examinations of the optimised protocol (p<0.002). CONCLUSION Optimising contrast medium flux and matching bolus duration to the CT technology dramatically improves the vascular access component of TAVI planning and provides a reliable method to achieve objectively enhanced arterial opacification. This work highlights how to obtain good arterial contrast medium opacification in haemodynamically fragile patients without excessive contrast medium volumes.
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Affiliation(s)
- H M E I Komber
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK.
| | - S Neumann
- Faculty of Life Sciences, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Senate House, Tyndall Ave, Bristol BS8 1TH, UK
| | - J Paull
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - M Gesteira Andrade
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - S M Lyen
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - N E Manghat
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - M C K Hamilton
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK
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Pineda AM, Rymer J, Wang A, Banks AZ, Koweek LH, Plichta R, Williams A, Vavalle JP, Halim S, Kiefer T, Wang A, Gaca J, Hughes GC, Harrison JK. Transcatheter aortic valve replacement for patients with severe bicuspid aortic stenosis. Am Heart J 2020; 224:105-112. [PMID: 32361278 DOI: 10.1016/j.ahj.2020.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with bicuspid aortic valve stenosis (BAV) were excluded from all the trileaflet aortic valve stenosis (TAV) pivotal trials, and therefore, their outcomes are not clearly defined. The aim of the study was to evaluate the outcomes of transcatheter aortic valve replacement (TAVR) in patients with BAV and compared them with those of TAV. METHODS We evaluated the outcomes following TAVR of patients with BAV at our institution between April 2011 and November 2016 and compared them with the outcomes of patients with TAV treated with TAVR. The χ2 and the Mann-Whitney U tests were used to compare the groups, and a Kaplan-Meier analysis was performed to estimate long-term survival. RESULTS TAVR was performed in a total of 567 patients, from which 50 (8.8%) had BAV and 517 (91.2%) had TAV. Patients with BAV were younger and had higher prevalence of chronic obstructive pulmonary disease, lower prevalence of coronary artery disease, higher body mass index, and lower Society of Thoracic Surgeons score (STS PROM). Patients with BAV had a slightly higher mean aortic valve gradient postoperatively (median 12 mm Hg [10-15] vs 10 [7-13], P < .001), but paravalvular aortic regurgitation was not different between the groups (> mild 4.0% vs 3.5%, P = .541). Clinical outcomes were not different between the groups, including stroke (2.0% vs 1.5, P = .567) and the 30-day all-cause mortality (6.0% vs 1.5, P = .064). The 2-year survival (82.0% vs 83.4, P = .476) was similar between the groups. CONCLUSIONS This initial experience suggests that TAVR can be safely performed in patients with BAV, achieving similar short-term procedural and clinical outcomes when compared with patients with TAV.
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Obmann MM, Gehweiler J, Schindera ST, Janetzki J, Boll DT, Benz MR. Clinical evaluation of a novel multibolus contrast agent injection protocol for thoraco-abdominal CT angiography: Assessment of homogeneity of arterial contrast enhancement. Eur J Radiol 2020; 126:108957. [PMID: 32244065 DOI: 10.1016/j.ejrad.2020.108957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the in vivo feasibility of a multibolus contrast agent (CA) injection protocol with a reduced CA volume for thoraco-abdominal CT angiography (CTA) and to compare it to a single-bolus CA injection protocol. METHOD 63 patients who underwent CTA with the multibolus protocol (60 ml CA) were divided in two groups either without (group 1, n = 48) or with (group 2, n = 15) aortic dissection. The aortic contrast enhancement was measured in group 1 using manual ROI analysis (10 segments), as well as semi-automated linear attenuation profiles. A subgroup (n = 18) of group 1, who also underwent imaging with the single-bolus protocol (94 ml CA), was used to compare both protocols. In group 2, differences in attenuation of the true and the false lumen for both the single- and the multibolus protocol were assessed with ROI attenuation measurements in both lumina. Comparisons were made using Wilcoxon test. RESULTS Average attenuation was above 200 HU for 98 % of cases using the multibolus protocol. There was superior contrast homogeneity for the multibolus protocol with a lower standard deviation of attenuation values along the length of the scan (p = 0.003), while average attenuation was higher for the single-bolus protocol (p = 0.002). Prolonged enhancement plateau lead to a more uniform opacification of the true and the false lumen in patients with aortic dissection using the multibolus protocol (p = 0.012). CONCLUSIONS The multibolus protocol in thoraco-abdominal CTA is feasible in patients. It shows consistently high arterial enhancement with superior contrast homogeneity compared to a single-bolus protocol in patients with and without aortic dissection.
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Affiliation(s)
- Markus M Obmann
- Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Switzerland.
| | - Julian Gehweiler
- Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Switzerland
| | | | - Julia Janetzki
- Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Switzerland
| | - Daniel T Boll
- Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Switzerland
| | - Matthias R Benz
- Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Switzerland.
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Lee JW, Kim CW, Lee G, Lee HC, Kim SP, Choi BS, Jeong YJ. Hybrid ECG-gated versus non-gated 512-slice CT angiography of the aorta and coronary artery: image quality and effect of a motion correction algorithm. Acta Radiol 2018; 59:170-179. [PMID: 28475022 DOI: 10.1177/0284185117707358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Using the hybrid electrocardiogram (ECG)-gated computed tomography (CT) technique, assessment of entire aorta, coronary arteries, and aortic valve can be possible using single-bolus contrast administration within a single acquisition. Purpose To compare the image quality of hybrid ECG-gated and non-gated CT angiography of the aorta and evaluate the effect of a motion correction algorithm (MCA) on coronary artery image quality in a hybrid ECG-gated aorta CT group. Material and Methods In total, 104 patients (76 men; mean age = 65.8 years) prospectively randomized into two groups (Group 1 = hybrid ECG-gated CT; Group 2 = non-gated CT) underwent wide-detector array aorta CT. Image quality, assessed using a four-point scale, was compared between the groups. Coronary artery image quality was compared between the conventional reconstruction and motion correction reconstruction subgroups in Group 1. Results Group 1 showed significant advantages over Group 2 in aortic wall, cardiac chamber, aortic valve, coronary ostia, and main coronary arteries image quality (all P < 0.001). All Group 1 patients had diagnostic image quality of the aortic wall and left ostium. The MCA significantly improved the image quality of the three main coronary arteries ( P < 0.05). Moreover, per-vessel interpretability improved from 92.3% to 97.1% with the MCA ( P = 0.013). Conclusion Hybrid ECG-gated CT significantly improved the heart and aortic wall image quality and the MCA can further improve the image quality and interpretability of coronary arteries.
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Affiliation(s)
- Ji Won Lee
- 1 Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Chang Won Kim
- 1 Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Geewon Lee
- 1 Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Han Cheol Lee
- 2 Department of Cardiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Sang-Pil Kim
- 3 Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Bum Sung Choi
- 4 Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yeon Joo Jeong
- 1 Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
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Whole-Body High-Pitch CT Angiography: Strategies to Reduce Radiation Dose and Contrast Volume. AJR Am J Roentgenol 2017; 209:1396-1403. [DOI: 10.2214/ajr.16.17695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Shuman WP, Green DE, Busey JM, Ramos MM, Branch KR, Koprowicz KM, Kanal KM. Wide-detector axial CT versus 4 cm detector helical CT for transcatheter aortic valve replacement: iodine dose, radiation, and image quality. Clin Imaging 2016; 40:1213-1218. [DOI: 10.1016/j.clinimag.2016.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/24/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Mileto A, Heye TJ, Makar RA, Hurwitz LM, Marin D, Boll DT. Regional Mapping of Aortic Wall Stress by Using Deformable, Motion-coherent Modeling based on Electrocardiography-gated Multidetector CT Angiography: Feasibility Study. Radiology 2016; 280:230-6. [PMID: 26780540 DOI: 10.1148/radiol.2015151078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the feasibility of deformable, motion-coherent modeling based on electrocardiography-gated multidetector computed tomographic (CT) angiography of the thoracic aorta and to evaluate whether quantifiable information on aortic wall stress as a function of patient-specific cardiovascular parameters can be gained. Materials and Methods For this institutional review board-approved, HIPAA-compliant study, thoracic electrocardiography-gated dual-source multidetector CT angiographic images were used from 250 prospectively enrolled patients (150 men, 100 women; mean age, 79 years). On reconstructed 50-phase CT angiographic images, aortic strain and deformation were determined at seven cardiac and aortic locations. One-way analysis of variance was used by assessing the magnitude for longitudinal and axial strain and axial deformation, as well as time-resolved peak and maxima count for longitudinal strain and axial deformation. Interdependencies between aortic strain and deformation with extracted hemodynamic parameters were evaluated. Results With increasing heart rates, there was a significant decrease in longitudinal strain (P = .009, R(2) = 0.95) and a decrease in the number of longitudinal strain peaks (P < .001, R(2) = 0.79); however, a significant increase in axial deformation (P < .001, R(2) = 0.31) and axial strain (P = .009, R(2) = 0.61) was observed. Increasing aortic blood velocity led to increased longitudinal strain (P = .018, R(2) = 0.42) and longitudinal strain peak counts (P = .011, R(2) = 0.48). Pronounced motion in the longitudinal direction limited motion in the axial plane (P < .019, R(2) = 0.29-0.31). Conclusion The results of this study render a clinical basis and provide proof of principle for the use of deformable, motion-coherent modeling to provide quantitative information on physiological motion of the aorta under various hemodynamic circumstances. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Achille Mileto
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Tobias J Heye
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Ryan A Makar
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Lynne M Hurwitz
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Daniele Marin
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
| | - Daniel T Boll
- From the Department of Radiology, Duke University Medical Center, Durham, NC (A.M., R.A.M., L.M.H., D.M., D.T.B.); and Department of Radiology, University Hospital of Basel, 4048 Basel, Switzerland (T.J.H., D.T.B.)
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First Clinical Evaluation of High-Pitch Dual-Source Computed Tomographic Angiography Comparing Automated Tube Potential Selection With Automated Tube Current Modulation. J Comput Assist Tomogr 2015; 39:624-8. [PMID: 25955395 DOI: 10.1097/rct.0000000000000247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate and compare the use of automated tube potential selection (ATPS) with automated tube current modulation (ATCM) in high-pitch dual-source computed tomographic angiography (CTA) for imaging the whole aorta without electrocardiogram synchronization. METHODS Two groups of 60 patients underwent CTA on a dual-source computed tomographic device in high-pitch mode: ATCM (with 100-kV fixed tube potential) was used in group 1 and ATPS (with the same image quality options) in group 2. For the evaluation of radiation exposure, CT dose index and dose-length product were analyzed. Contrast and image quality were assessed by 2 independent observers. RESULTS The ATPS group received a higher radiation dose than the ATCM group (P < 0.001) because in 80% of patients, the software switched to use of a 120-kV tube potential. In all cases, images of the aorta were of sufficient quality. CONCLUSIONS High-pitch dual-source CTA of the aorta using ATPS is feasible in clinical routine, but is associated with higher radiation exposure than the ATCM protocol. This finding contradicts previously evaluations of ATPS based on single-source techniques.
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