Comparative analysis of pre-transcatheter aortic valve implantation CTA protocols: Optimizing radiation dose and contrast volume

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2025-06-14 DOI:10.1016/j.ijcard.2025.133514

Giuseppe Tremamunno , Domenico De Santis , Curzio Santangeli , Giovanna G. Bona , Tiziano Polidori , Federica Fanelli , Luca Pugliese , Carlo Di Donna , Marta Zerunian , Chiara Catamo , Marta Belmonte , Matteo Casenghi , Emanuele Barbato , Andrea Laghi , Damiano Caruso

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引用次数: 0

Abstract

Background

To establish the most effective and safe pre-transcatheter aortic valve implantation (TAVI) CT angiography (CTA) protocol by comparing two approaches in terms of image quality, radiation and contrast dose.

Methods

Consecutive patients undergoing pre-procedural CTA were prospectively enrolled from January to May 2024. Patients were randomly assigned into two different acquisition protocols: group A underwent an ECG-gated CTA of the thorax followed by a non-gated helical scan of abdomen and pelvis; group B underwent an ECG-gated CTA including only the heart and aortic root, followed by a non-gated helical scan of thorax, abdomen, and pelvis. Objective image analysis was performed by evaluating vascular attenuation, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) in multiple segments. Subjective image analysis was evaluated by two radiologists and radiation and contrast dose were compared between the groups.

Results

The final population consisted of 64 patients, 37 in group A and 27 in group B (80.6 ± 5.2 years; 49 males). Group B showed lower radiation dose compared to group A (13.7 ± 1.2 vs 15.7 ± 1.4 mSv; p < 0.001) and lower contrast medium volume (82.9 ± 10.1 vs 90.3 ± 12.0 ml; p = 0.004) while achieving no differences in terms of signal-to-noise ratio, contrast-to-noise ratio and subjective image quality (all p > 0.05). Average vascular attenuation was higher in group A compared to group B (707.1 ± 120.7 vs 633.0 ± 198.6 HU; p < 0.001); however, lumen attenuation at the aortic root was consistent across the two protocols (p = 0.077).

Conclusions

Optimization of pre-TAVI CTA protocol results in lower contrast medium volume and radiation dose exposure while maintaining consistent image quality.

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经导管主动脉瓣置入术前CTA方案的比较分析：优化辐射剂量和造影剂体积

背景通过比较两种方法在图像质量、辐射和造影剂方面的差异，建立最有效、安全的经导管前主动脉瓣植入术（TAVI） CT血管造影（CTA）方案。方法前瞻性纳入2024年1月至5月连续行术前CTA的患者。患者被随机分配到两个不同的获取方案中：A组接受心电图门控的胸部CTA扫描，然后进行腹部和骨盆的非门控螺旋扫描；B组患者行心电图门控CTA，仅包括心脏和主动脉根部，随后行胸、腹、骨盆非门控螺旋扫描。通过评价多段血管衰减、对比噪声比（CNR）和信噪比（SNR）进行客观的图像分析。由两名放射科医师评估主观影像分析，并比较两组间的放射线和对比剂量。结果最终患者64例，其中A组37例，B组27例(80.6±5.2岁；49岁男性)。B组放射剂量低于A组(13.7±1.2 vs 15.7±1.4 mSv；p & lt;0.001)和较低造影剂体积（82.9±10.1 vs 90.3±12.0 ml）；P = 0.004)，而在信噪比、噪比和主观图像质量方面均无差异(P >；0.05)。A组血管平均衰减高于B组（707.1±120.7 vs 633.0±198.6 HU）；p & lt;0.001);然而，主动脉根部的管腔衰减在两种方案中是一致的（p = 0.077）。结论优化tavi前CTA方案，在保证图像质量的前提下，降低了对比介质体积和辐射剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.