Imaging of the Left Atrial Appendage Before Occluder Device Placement: Evaluation of Virtual Monoenergetic Images in a Single-Bolus Dual-Phase Protocol.

Autor:	Laukamp KR, Dastmalchian S, Tandon YK, Ciancibello L; From the Department of Radiology, University Hospitals Cleveland Medical Center., Pennig L; Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany., Lennartz S; Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany., Al-Kindi S; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH., Rajagopalan S; Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH., Bera K, Hokamp NG; Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany., Gilkeson R, Gupta A
Jazyk:	angličtina
Zdroj:	Journal of computer assisted tomography [J Comput Assist Tomogr] 2022 Sep-Oct 01; Vol. 46 (5), pp. 735-741. Date of Electronic Publication: 2022 Jun 18.
DOI:	10.1097/RCT.0000000000001330
Abstrakt:	Purpose: Preimplantation cardiac computed tomography (CT) for assessment of the left atrial appendage (LAA) enables correct sizing of the device and the detection of contraindications, such as thrombi. In the arterial phase, distinction between false filling defects and true thrombi can be hampered by insufficient contrast medium distribution. A delayed scan can be used to further differentiate both conditions, but contrast in these acquisitions is relatively lower. In this study, we investigated whether virtual monoenergetic images (VMI) from dual-energy spectral detector CT (SDCT) can be used to enhance contrast and visualization in the delayed phase. Materials and Methods: Forty-nine patients receiving SDCT imaging of the LAA were retrospectively enrolled. The imaging protocol comprised dual-phase acquisitions with single-bolus contrast injection. Conventional images (CI) from both phases and 40-keV VMI from the delayed phase were reconstructed. Attenuation, signal-, and contrast-to-noise ratios (SNR/CNR) were calculated by placing regions-of-interest in the LAA, left atrium, and muscular portion of interventricular septum. Two radiologists subjectively evaluated conspicuity and homogeneity of contrast distribution within the LAA. Results: Contrast of the LAA decreased significantly in the delayed phase but was significantly improved by VMI, showing comparable attenuation, SNR, and CNR to CI from the arterial phase (attenuation/SNR/CNR, CI arterial phase: 266.0 ± 117.0 HU/14.2 ± 7.2/6.6 ± 3.9; CI-delayed phase: 107.6 ± 35.0 HU/5.9 ± 3.0/1.0 ± 1.0; VMI delayed phase: 260.3 ± 108.6 HU/18.2 ± 10.6/4.8 ± 3.4). The subjective reading confirmed the objective findings showing improved conspicuity and homogeneity in the delayed phase. Conclusions: The investigated single-bolus dual-phase acquisition protocol provided improved visualization of the LAA. Homogeneity of contrast media was higher in the delayed phase, while VMI maintained high contrast. Competing Interests: R.C.G. discloses research support from Philips Medical, General Electric, and Siemens and is a consultant for Riverain Medical and Heartflow. A.G. discloses research support from GE Healthcare. The other authors declare no conflict of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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