Comparison of a High-Pitch Non-ECG-Gated and a Prospective ECG-Gated Protocol for Preprocedural Computed Tomography Imaging Before TAVI/TAVR

Abstract

Purpose Preprocedural computed tomography (CT) imaging before transcatheter aortic valve implantation/replacement (TAVI/TAVR) requires high diagnostic accuracy without motion artifacts. The aim of this retrospective study is to compare the image quality of a high-pitch non-electrocardiography (ECG)-gated CT protocol used in patients with atrial tachyarrhythmias with a prospectively ECG-gated CT protocol used in patients with sinus rhythm.

Materials and Methods We retrospectively included 108 patients who underwent preprocedural CT imaging before TAVI/TAVR. 52 patients with sinus rhythm were imaged using a prospectively ECG-gated protocol (Group A), and 56 patients with atrial tachyarrhythmias were imaged using the high-pitch non-ECG-gated protocol (Group B). Image quality was rated subjectively by two experienced radiologists and assessed by objective parameters including radiation dose, image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) at the levels of the aortic root and abdominal aorta.

Results Subjective image quality was equally good with both CT protocols, and interrater agreement was substantial in both groups but tended to be higher in Group B at the level of the aortic root (Group A: κw = 0.644, Group B: κw = 0.741). With the high-pitch non-ECG-gated CT protocol, image noise was significantly increased (p = 0.001), whereas the SNR, CNR, and radiation dose were significantly decreased (p = 0.002, p = 0.003, and p < 0.001, respectively) at the level of the aortic root compared to the prospectively ECG-gated CT protocol.

Conclusion The high-pitch non-ECG-gated protocol yields images with similar subjective image quality compared with the prospectively ECG-gated CT protocol and allows motion-free assessment of the aortic root for accurate TAVI/TAVR planning. The high-pitch non-ECG-gated protocol may be used as an alternative for preprocedural CT imaging in patients with atrial tachyarrhythmias.

Key Points: 

• In patients with atrial tachyarrhythmias, a high-pitch non-ECG-gated CT protocol achieves similar subjective image quality compared to a prospective ECG-gated CT protocol.

• At the level of the aortic root, image noise is significantly increased, whereas SNR and CNR are significantly decreased using the high-pitch non-ECG-gated protocol.

• Radiation dose is reduced by 55 % using the high-pitch non-ECG-gated protocol.

Citation Format

• Shnayien S, Beetz N, Bressem KK et al. Comparison of a High-Pitch Non-ECG-Gated and a Prospective ECG-Gated Protocol for Preprocedural Computed Tomography Imaging Before TAVI/TAVR. Fortschr Röntgenstr 2023; 195: 139 – 147

Zusammenfassung

Ziel Die präinterventionelle Bildgebung mittels Computertomografie (CT) vor geplanter Transkatheter-Aortenklappen-Implantation (TAVI) erfordert eine hohe diagnostische Genauigkeit ohne Bewegungsartefakte. Ziel dieser retrospektiven Studie ist es, die Bildqualitäten eines „high-pitch“ nicht Elektrokardiogramm (EKG)-getriggerten CT-Protokolls bei Patienten mit atrialer Tachyarrhythmie und eines prospektiv EKG-getriggerten CT-Protokolls bei Patienten mit Sinusrhythmus zu vergleichen.

Material und Methoden Es wurden 108 Patient*innen mit einer präinterventionellen CT-Bildgebung vor geplanter TAVI retrospektiv eingeschlossen. 52 Patient*innen wurden mit dem prospektiv EKG-getriggerten CT-Protokoll untersucht (Gruppe A), während 56 Patient*innen mit atrialer Tachyarrhythmie mit dem „high pitch“ nicht EKG-getriggerten CT-Protokoll untersucht wurden. Die Bildqualität wurde von 2 erfahrenen Radiologen beurteilt. Zudem wurden die objektiven Bildparameter Strahlendosis, Bildrauschen, Kontrast-Rausch-Verhältnis und Signal-Rausch-Verhältnis auf Höhe der Aortenwurzel und der abdominellen Aorta verglichen.

Ergebnisse Unabhängig von dem verwendeten CT-Protokoll war die Bildqualität gleich gut und die Interrater-Reliabilität substantiell, aber tendenziell besser in Gruppe B auf Höhe der Aortenwurzel (Gruppe A: κw = 0.644 und Gruppe B: κw = 0.741). Bei der Verwendung des „high-pitch“ nicht EKG-getriggerten CT-Protokolls war das Bildrauschen auf Höhe der Aortenwurzel signifikant erhöht (p = 0.001), wogegen das Kontrast-Rausch-Verhältnis, das Signal-Rausch-Verhältnis sowie die Strahlendosis signifikant reduziert waren (p = 0.002, p = 0.003, und p < 0.001) im Vergleich zum prospektiv EKG-getriggerten CT-Protokoll.

Schlussfolgerung Das „high-pitch“ nicht EKG-getriggerte CT-Protokoll bietet eine ähnliche subjektive Bildqualität verglichen mit dem prospektiv EKG-getriggerten CT-Protokoll und erlaubt eine bewegungsfreie Beurteilung der Aortenwurzel für eine akkurate TAVI-Planung. Das „high-pitch“ nicht EKG-getriggerte CT-Protokoll könnte eine Alternative für die präinterventionelle CT-Bildgebung bei Patient*innen mit atrialer Tachyarrhythmie darstellen.

Kernaussagen: 

• Bei Patient*innen mit atrialer Tachyarrhythmie kann das „high-pitch“ nicht EKG-getriggerte CT-Protokoll im Vergleich zu dem EKG-getriggerten CT-Protokoll eine vergleichbare subjektive Bildqualität erzeugen.

• Bei dem „high-pitch“ nicht EKG-getriggerten CT-Protokoll ist das Bildrauschen auf Höhe der Aortenwurzel signifikant erhöht, während das Kontrast-Rausch-Verhältnis und Signal-Rausch-Verhältnis signifikant verringert sind.

• Bei dem „high-pitch“ nicht EKG-getriggerten CT-Protokoll wird die Strahlendosis um 55 % reduziert.

Key words

aortic valve - cardiac - CT-angiography

Publication History

Received: 05 January 2022

Accepted: 19 June 2022

Article published online:
05 September 2022

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