High-pitch Dual-source CT Angiography before TAVI - the Value of ECG Gating

Author(s): Andreas Michael Bucher, Moritz Hans Albrecht, Jan Erik Scholtz, Eva Herrmann, Moritz Kaup, Tatjana Gruber-Rouh, Volkmar Jacobi, Thomas Josef Vogl, Martin Beeres*

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 15 , Issue 4 , 2019

Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


Purpose: To investigate image quality, and radiation dose between ECG-gated singlesource and dual-source CT Angiography (CTA) protocols for planning of Trans-catheter Aortic Valve Implantation (TAVI) with a reference non ECG-gated single-source protocol.

Methods: A total of 120 patients were included in four groups: Non ECG-gated single-source (SS), ECG-gated single-source (SSECG), ECG-gated dual-source high-pitch (DSECG), or non-ECG-gated dual-source high-pitch mode (DS). Qualitative image quality of the aortic annulus, aortic valve, and coronary ostia as well as presence of motion or stair-step artefacts of the thoracic aorta were independently assessed by two readers. Quantitative image quality was assessed to calculate contrast to noise ratio.

Results: Subjective and objective scoring of motion artefacts was significantly reduced in SSECG, DSECG and DS (p= 0.010). The imaging length was comparable between groups. Aortic annulus, aortic valve, and coronary ostia were reliably evaluable in all patients with SSECG, DSECG and DS protocols.

Conclusion: High-pitch, dual-source CT angiography of the whole aorta with or without ECG gating is a dose-efficient and time-saving examination strategy before TAVI. However acquisition timing within the cardiac cycle needs to be taken into account.

Keywords: TAVI, CT angiography, aorta, high-pitch, dual-source CT, radiation dose.

Zahn R, Schiele R, Kilkowski C, et al. Transcatheter aortic valve implantation (TAVI)TAVI): A new therapeutic option for patients with severe symptomatic aortic stenosis who are not suitable or at high risk for surgical valve replacement. Dtsch Med Wochenschr 2010; 135(33): 1589-95.
Prendergast BD, Naber CK, Popma JJ. Transatlantic perspectives on TAVI: from essential infrastructure and integration to expansion, research and development. Heart 2012; 98: iv37-43.
Masson JB, Kovac J, Schuler G, et al. Transcatheter aortic valve implantation: review of the nature, management, and avoidance of procedural complications. JACC Cardiovasc Interv 2009; 2(9): 811-20.
Grimaldi A, Figini F, Maisano F, et al. Clinical outcome and quality of life in octogenarians following Transcatheter Aortic Valve Implantation (TAVI) for symptomatic aortic stenosis. Int J Cardiol 2013; 168(1): 281-6.
Clarke A, Wiemers P, Poon KK, et al. Early experience of transaortic TAVI--the future of surgical TAVI? Heart Lung Circ 2013; 22(4): 265-9.
Schultz CJ, Moelker AD, Tzikas A, et al. Cardiac CT: Necessary for precise sizing for transcatheter aortic implantation. EuroIntervention 2010; 6: G6-G13.
Rixe J, Schuhbaeck A, Liebetrau C, et al. Multi-detector computed tomography is equivalent to trans-oesophageal echocardiography for the assessment of the aortic annulus before transcatheter aortic valve implantation. Eur Radiol 2012; 22(12): 2662-9.
Latsios G, Gerckens U, Buellesfeld L, et al. “Device landing zone” calcification, assessed by MSCT, as a predictive factor for pacemaker implantation after TAVI. Catheter Cardiovasc Interv 2010; 76(3): 431-9.
Kempfert J, Van Linden A, Lehmkuhl L, et al. Aortic annulus sizing: echocardiographic versus computed tomography derived measurements in comparison with direct surgical sizing. Eur J Cardiothorac Surg 2012; 42(4): 627-33.
Johnson PT, Horton KM, Fishman EK. Aortic valve and ascending thoracic aorta: Evaluation with isotropic MDCT. AJR Am J Roentgenol 2010; 195(5): 1072-81.
Davin L, Bruyere PJ, Lancellotti P, Pierard L, Legrand V. Multimodal cardiovascular imaging before aortic valve transcatheter replacement. Rev Med Liege 2013; 68(2): 86-93.
Bennett CJ, Maleszewski JJ, Araoz PA. CT and MR imaging of the aortic valve: radiologic-pathologic correlation. Radiographics 2012; 32(5): 1399-420.
Blanke P, Bulla S, Baumann T, et al. Thoracic aorta: Prospective electrocardiographically triggered CT angiography with dual-source CT--feasibility, image quality, and dose reduction. Radiology 2010; 255(1): 207-17.
Goetti R, Feuchtner G, Stolzmann P, et al. High-pitch dual-source CT coronary angiography: Systolic data acquisition at high heart rates. Eur Radiol 2010; 20(11): 2565-71.
Lell M, Marwan M, Schepis T, et al. Prospectively ECG-triggered high-pitch spiral acquisition for coronary CT angiography using dual source CT: Technique and initial experience. Eur Radiol 2009; 19(11): 2576-83.
Sommer WH, Schenzle JC, Becker CR, et al. Saving dose in triple-rule-out computed tomography examination using a high-pitch dual spiral technique. Invest Radiol 2010; 45(2): 64-71.
Roos JE, Willmann JK, Weishaupt D, et al. Thoracic aorta: Motion artifact reduction with retrospective and prospective electrocardiography-assisted multi-detector row CT. Radiology 2002; 222(1): 271-7.
Plank F, Friedrich G, Bartel T, et al. Benefits of high-pitch 128-slice dual-source computed tomography for planning of transcatheter aortic valve implantation. Ann Thorac Surg 2012; 94(6): 1961-6.
Wuest W, Anders K, Schuhbaeck A, et al. Dual source multidetector CT-angiography before Transcatheter Aortic Valve Implantation (TAVI) using a high-pitch spiral acquisition mode. Eur Radiol 2012; 22(1): 51-8.
Hachulla AL, Ronot M, Noble S, et al. ECG-triggered high-pitch CT for simultaneous assessment of the aorta and coronary arteries. J Cardiovasc Comput Tomogr 2016; 10(5): 407-13.
Tops LF, Wood DA, Delgado V, et al. Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. JACC Cardiovasc Imaging 2008; 1(3): 321-30.
Kasel AM, Cassese S, Bleiziffer S, et al. Standardized imaging for aortic annular sizing: Implications for transcatheter valve selection. JACC Cardiovasc Imaging 2013; 6(2): 249-62.
Karlo C, Leschka S, Goetti RP, et al. High-pitch dual-source CT angiography of the aortic valve-aortic root complex without ECG-synchronization. Eur Radiol 2011; 21(1): 205-12.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Published on: 27 May, 2018
Page: [373 - 379]
Pages: 7
DOI: 10.2174/1573405614666180528102949
Price: $65

Article Metrics

PDF: 35
PRC: 1