Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning

Eur Radiol. 2017 May;27(5):1944-1953. doi: 10.1007/s00330-016-4537-6. Epub 2016 Aug 23.


Purpose: To investigate feasibility, image quality and safety of low-tube-voltage, low-contrast-volume comprehensive cardiac and aortoiliac CT angiography (CTA) for planning transcatheter aortic valve replacement (TAVR).

Materials and methods: Forty consecutive TAVR candidates prospectively underwent combined CTA of the aortic root and vascular access route (270 mgI/ml iodixanol). Patients were assigned to group A (second-generation dual-source CT [DSCT], 100 kV, 60 ml contrast, 4.0 ml/s flow rate) or group B (third-generation DSCT, 70 kV, 40 ml contrast, 2.5 ml/s flow rate). Vascular attenuation, noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were compared. Subjective image quality was assessed by two observers. Estimated glomerular filtration (eGFR) at CTA and follow-up were measured.

Results: Besides a higher body-mass-index in group B (24.8±3.8 kg/m2 vs. 28.1±5.4 kg/m2, P=0.0339), patient characteristics between groups were similar (P≥0.0922). Aortoiliac SNR (P=0.0003) was higher in group B. Cardiac SNR (P=0.0003) and CNR (P=0.0181) were higher in group A. Subjective image quality was similar (P≥0.213) except for aortoiliac image noise (4.42 vs. 4.12, P=0.0374). TAVR-planning measurements were successfully obtained in all patients. There were no significant changes in eGFR among and between groups during follow-up (P≥0.302).

Conclusion: TAVR candidates can be safely and effectively evaluated by a comprehensive CTA protocol with low contrast volume using low-tube-voltage acquisition.

Key points: • Third-generation dual-source CT facilitates low-tube-voltage acquisition. • TAVR planning can be performed with reduced contrast volume and radiation dose. • TAVR-planning CT did not result in changes in creatinine levels at follow-up. • TAVR candidates can be safely evaluated by comprehensive low-tube-voltage CT angiography.

Keywords: Aortic stenosis; Aortoiliac CT angiography; Contrast medium; Dual-source CT; Transcatheter aortic valve replacement.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / surgery
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / surgery*
  • Computed Tomography Angiography / methods*
  • Cone-Beam Computed Tomography / methods
  • Contrast Media
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Patient Care Planning
  • Radiation Dosage
  • Retrospective Studies
  • Transcatheter Aortic Valve Replacement / methods*
  • Triiodobenzoic Acids


  • Contrast Media
  • Triiodobenzoic Acids
  • iodixanol