Computer-aided evaluation of low-dose and low-contrast agent third-generation dual-source CT angiography prior to transcatheter aortic valve implantation (TAVI)
| Autor: | Peter Dankerl, Hannes Seuss, Michael Uder, Stephan Achenbach, Monique Tröbs, Mohamed Marwan, Michaela M. Hell, Alexander Cavallaro, Annika Schuhbaeck, Matthias Hammon |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Cardiac Catheterization Computed Tomography Angiography medicine.medical_treatment Contrast Media 030204 cardiovascular system & hematology Prosthesis 030218 nuclear medicine & medical imaging Automation Electrocardiography 0302 clinical medicine Diagnosis Computer-Assisted Prospective Studies Cardiac skeleton Computed tomography angiography Aged 80 and over Heart Valve Prosthesis Implantation medicine.diagnostic_test Low dose General Medicine Reference Standards Computer Graphics and Computer-Aided Design Computer Science Applications Aortic Valve cardiovascular system Female Computer Vision and Pattern Recognition Radiology medicine.medical_specialty Transcatheter aortic Biomedical Engineering Health Informatics Iliac Artery Transcatheter Aortic Valve Replacement 03 medical and health sciences medicine.artery Preoperative Care medicine Humans Radiology Nuclear Medicine and imaging Aged Aorta business.industry Annulus (oil well) Aortic Valve Stenosis Fluoroscopy Angiography Surgery business Software |
| Zdroj: | International Journal of Computer Assisted Radiology and Surgery. 12:795-802 |
| ISSN: | 1861-6429 1861-6410 |
| DOI: | 10.1007/s11548-016-1470-8 |
| Popis: | To evaluate the performance of computer-aided evaluation software for a comprehensive workup of patients prior to transcatheter aortic valve implantation (TAVI) using low-contrast agent and low radiation dose third-generation dual-source CT angiography. We evaluated 30 consecutive patients scheduled for TAVI. All patients underwent ECG-triggered high-pitch dual-source CT angiography of the aortic root and aorta with a standardized contrast agent volume (30 ml Imeron350, flow rate 4 ml/s) and low-dose (100 kv/350 mAs) protocol. An expert (10 years of experience) manually evaluated aortic root and iliac access dimensions (distance between coronary ostia and aortic annulus, minimal/maximal diameters and area-derived diameter of the aortic annulus) and best CT-predicted fluoroscopic projection angle as the reference standard. Utilizing computer-aided software (syngo.via), the same pre-TAVI workup was performed and compared to the reference standard. Mean CTDI $$_\mathrm{vol}$$ was 3.46 mGy and mean DLP 217.6 ± 12.1 mGy cm, corresponding to a mean effective dose of 3.7 ± 0.2 mSv. Computer-aided evaluation was successful in all but one patient. Compared to the reference standard, Bland–Altman analysis indicated very good agreement for the distances between aortic annulus and coronary ostia (RCA: mean difference 0.8 mm; 95 % CI 0.4–1.2 mm; LM: mean difference 0.9 mm; 95 % CI 0.5–1.3 mm); however, we demonstrated a systematic overestimation of annulus- derived diameter using the software (mean difference 44.4 mm $$^{2}$$ ; 95 % CI 30.4–58.3 mm $$^{2}$$ ). Based on respective annulus dimensions, the recommended prosthesis size (Edwards SAPIEN 3) matched in 26 out of the 29 patients (90 %). CT-derived fluoroscopic projection angles showed an excellent agreement for both methods. Out of 58 iliac arteries, 15 (25 %) arteries could not be segmented by the software. Preprocessing time of the software was 71 ± 11 s (range 51–96 s), and reading time with the software was 118 ± 31 s (range 68–201 s). In the workup of pre-TAVI CT angiography, computer-aided evaluation of low-contrast, low-dose examinations is feasible with good agreement and quick reading time. However, a systematic overestimation of the aortic annulus area is observed. |
| Databáze: | OpenAIRE |
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