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

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.