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Original Investigation| Volume 28, ISSUE 12, P1669-1674, December 01, 2021

Evaluation of ECG-gated and Fast Low-Angle Shot (FLASH) Dual Source Computed Tomography Scanning Protocols for Transcatheter Aortic Valve Replacement

Published:September 22, 2020DOI:https://doi.org/10.1016/j.acra.2020.08.027
Evaluation of ECG-gated and Fast Low-Angle Shot (FLASH) Dual Source Computed Tomography Scanning Protocols for Transcatheter Aortic Valve Replacement
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      Background

      Transcatheter aortic valve replacement (TAVR) procedural success relies heavily on volumetric reconstruction imaging, particularly ECG-gated multi-detector row computed tomography. We postulated that single examination using fast low-angle shot (FLASH) dual source CT scanning (DS-CTA) could provide lower dose than ECG-gated CTA while maintaining the image quality.

      Methods

      In this single-centre cohort study, all patients who underwent ECG-gated and FLASH DS-CTA were evaluated. Volumetric reconstructions were performed for both ECG-gated and FLASH DS-CTA to obtain nonsagittal views of the structures. ECG-gated cardiac CT was obtained to evaluate the aortic annular size while FLASH DS-CTA was obtained to examine the aortic and iliac vasculature as part of TAVR imaging protocol. We evaluated measures of aortic annulus, coronaries and sinus of Valsalva using ECG-gated and FLASH DS-CTA scanning protocols. Image quality assessments were performed using aortic root region-of-interest signal-to-noise ratio.

      Results

      A total of 130 patients (mean age 81.5 ± 9.2 years, 46.2% female, and 99.2% white) underwent both ECG-gated CT and FLASH DS-CTA. There were excellent correlations between aortic annular area (R2 = 0.934) and aortic annular perimeter (R2 = 0.923) measured by the two protocols. Only 2 (1.5%) patients had >10% difference between aortic annular measurements by ECG-gated and FLASH DS-CTA, while none of the patients had a >10% difference between aortic annular perimeter measured by ECG-gated and FLASH DS-CT scans. There was no significant difference in signal-to-noise ratio between the two methods (mean difference 13.4; 95% CI −2.1–28.8, p = 0.09). There was significantly lower radiation dose for FLASH DS-CTA than ECG-gated CT scan (mean dose-length product difference 404.38; 95% CI 328.9–479.87, p <0.001). The measurements by the two scans led to the same transcatheter valve size selection in majority of the 128 (98.5%) patients by balloon expandable valve sizing recommendations and 130 (100%) of patients by self-expanding valve sizing recommendations.

      Conclusion

      Overall, FLASH DS-CTA and ECG-gated CT scans provided comparable image quality and aortic annular dimensions for pre-TAVR evaluation. DS-CTA additionally provided the necessary angiographic imaging of the aorta and peripheral access vessels while still maintaining a lower radiation dose. We propose that a single non-ECG gated FLASH DS-CTA could be utilized to provide all the necessary pre-TAVR imaging information without a gated CT scan.
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      References

        • Leon M.B.
        • Smith C.R.
        • Mack M.
        • et al.
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        View in Article
        • Kapadia S.R.
        • Leon M.B.
        • Makkar R.R.
        • et al.
        5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial.
        Lancet. 2015; 385: 2485-2491
        View in Article
        • Fu J.
        • Popal M.S.
        • Li Y.
        • et al.
        Transcatheter versus surgical aortic valve replacement in low and intermediate risk patients with severe aortic stenosis: systematic review and meta-analysis of randomized controlled trials and propensity score matching observational studies.
        J Thorac Dis. 2019; 11: 1945-1962
        View in Article
        • Reardon M.J.
        • Van Mieghem N.M.
        • Popma J.J.
        • et al.
        Surgical or transcatheter aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2017; 376: 1321-1331
        View in Article
        • Arora S.
        • Misenheimer J.A.
        • Jones W.
        • et al.
        Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis.
        Cardiovasc Diagn Ther. 2016; 6: 241-249
        View in Article
        • Waksman R.
        • Rogers T.
        • Torguson R.
        • et al.
        Transcatheter aortic valve replacement in low-risk patients with symptomatic severe aortic stenosis.
        J Am Coll Cardiol. 2018; 72: 2095-2105
        View in Article
        • Popma J.J.
        • Deeb G.M.
        • Yakubov S.J.
        • et al.
        Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients.
        N Engl J Med. 2019; 380: 1706-1715
        View in Article
        • Mack M.J.
        • Leon M.B.
        • Thourani V.H.
        • et al.
        Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.
        N Engl J Med. 2019; 380: 1695-1705
        View in Article
        • Smith C.R.
        • Leon M.B.
        • Mack M.J.
        • et al.
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198
        View in Article
        • Adams D.H.
        • Popma J.J.
        • Reardon M.J.
        • et al.
        Transcatheter aortic-valve replacement with a self-expanding prosthesis.
        N Engl J Med. 2014; 370: 1790-1798
        View in Article
        • Blanke P.
        • Weir-McCall J.R.
        • 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; 13: 1-20
        View in Article
        • Sondergaard L.
        • Steinbruchel D.A.
        • Ihlemann N.
        • et al.
        Two-year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: the all-comers nordic aortic valve intervention randomized clinical trial.
        Circ Cardiovasc Interv. 2016; 9e003665
        https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.115.003665
        View in Article
        • Tamburino C.
        • Barbanti M.
        • D'Errigo P.
        • et al.
        1-Year Outcomes After Transfemoral Transcatheter or Surgical Aortic Valve Replacement: Results From the Italian OBSERVANT Study.
        J Am Coll Cardiol. 2015; 66: 804-812
        View in Article
        • Smettei O.A.
        • Sayed S.
        • M Al Habib A.
        • Alharbi F.
        • Abazid R.M.
        Ultra-fast, low dose high-pitch (FLASH) versus prospectively-gated coronary computed tomography angiography: Comparison of image quality and patient radiation exposure.
        J Saudi Heart Assoc. 2018; 30: 165-171
        View in Article
        • Koplay M.
        • Erdogan H.
        • Avci A.
        • et al.
        Radiation dose and diagnostic accuracy of high-pitch dual-source coronary angiography in the evaluation of coronary artery stenoses.
        Diagn Interv Imaging. 2016; 97: 461-469
        View in Article
        • Kothan S.
        • Tungjai M.
        An estimation of x-radiation output using mathematic model.
        American Journal of Applied Sciences. 2011; 8: 923
        View in Article
        • Altman D.G.
        • Bland J.M.
        Measurement in medicine: the analysis of method comparison studies.
        Journal of the Royal Statistical Society: Series D (The Statistician). 1983; 32: 307-317
        View in Article
        • Smettei O.A.
        • Sayed S.
        • Al Habib A.M.
        • Alharbi F.
        • Abazid R.M.
        Ultra-fast, low dose high-pitch (FLASH) versus prospectively-gated coronary computed tomography angiography: Comparison of image quality and patient radiation exposure.
        J Saudi Heart Assoc. 2018; 30: 165-171
        View in Article
        • Duarte R.
        • Miranda D.
        • Fernandez-Perez G.
        • Costa J.C.
        [Coronary CT angiography using a prospective protocol. Comparison of image quality and radiation dose between dual source CT and single source CT].
        Radiologia. 2013; 55: 315-322
        View in Article
        • Matt D.
        • Scheffel H.
        • Leschka S.
        • et al.
        Dual-source CT coronary angiography: image quality, mean heart rate, and heart rate variability.
        AJR Am J Roentgenol. 2007; 189: 567-573
        View in Article
        • Leschka S.
        • Wildermuth S.
        • Boehm T.
        • et al.
        Noninvasive coronary angiography with 64-section CT: effect of average heart rate and heart rate variability on image quality.
        Radiology. 2006; 241: 378-385
        View in Article
        • Brodoefel H.
        • Burgstahler C.
        • Tsiflikas I.
        • et al.
        Dual-source CT: effect of heart rate, heart rate variability, and calcification on image quality and diagnostic accuracy.
        Radiology. 2008; 247: 346-355
        View in Article
        • Wang R.
        • Xu X.-J.
        • Huang G.
        • et al.
        Comparison of image quality, diagnostic accuracy and radiation dose between flash model and retrospective ECG-triggered protocols in dual source computed tomography (DSCT) in congenital heart diseases.
        Pol J Radiol. 2017; 82: 114
        View in Article
        • de Heer L.M.
        • Budde R.P.
        • Mali W.P.
        • de Vos A.M.
        • van Herwerden L.A.
        • Kluin J.
        Aortic root dimension changes during systole and diastole: evaluation with ECG-gated multidetector row computed tomography.
        Int J Cardiovasc Imaging. 2011; 27: 1195-1204
        View in Article
        • Elattar M.A.
        • Vink L.W.
        • van Mourik M.S.
        • et al.
        Dynamics of the aortic annulus in 4D CT angiography for transcatheter aortic valve implantation patients.
        PloS one. 2017; 12e0184133
        View in Article
        • Bertaso A.G.
        • Wong D.T.
        • Liew G.Y.
        • et al.
        Aortic annulus dimension assessment by computed tomography for transcatheter aortic valve implantation: differences between systole and diastole.
        Int J Cardiovasc Imaging. 2012; 28: 2091-2098
        View in Article

      Article Info

      Publication History

      Published online: September 22, 2020
      Accepted: August 25, 2020
      Received in revised form: August 24, 2020
      Received: June 6, 2020

      Identification

      DOI: https://doi.org/10.1016/j.acra.2020.08.027

      Copyright

      © 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

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