Diagnostic value of iterative reconstruction algorithm in low kV CT angiography (CTA) with low contrast medium volume for transcatheter aortic valve implantation (TAVI) planning: Image quality and radiation dose exposure

Objective: To evaluate image quality and radiation dose exposure of low-kV (100 kV) and low contrast medium (CM) volume CT angiography (CTA) in patients candidate to Transcatheter Aortic Valve Implantation (TAVI), in comparison with standard CTA protocol. Methods: 79 patients candidate for TAVI were prospectively enrolled in this study and examined with 256-MDCT. 42 patients were evaluated using study-group protocol (100 kV; whole-body retrospective ECG-gating; with 50 ml of CM; iterative reconstruction algorithm) while 37 patients underwent a standard CTA study (120 kV; ECG-gating for chest; 100 ml of CM; FBP reconstruction). Overall image quality was evaluated using a 4-point scale. Vascular enhancement (HU) was then assessed in each patient by manually drawing multiple ROIs in lumen of 7 segments of the whole aorta. The radiation dose exposure of both groups was calculated and all data were compared and statistically analyzed. Results: On low-kV protocol, higher mean attenuation values were achieved in all the measurements as compared to standard protocol. There were no significant differences in the image quality evaluation in both groups. Mean radiation dose value of study group was significantly lower than in control group (reduction of 20%). Conclusion: Low kV and low CM volume CTA protocols allow TAVI planning to be carried out with high quality images and a significant reduction in the radiation dose as compared to the standard CTA protocol. Advances in knowledge: Low-kV CTA for pre-operative assessment of patients candidates for TAVI, permits to achieve a significant reduction of radiation dose exposure and contrast medium volume, reducing the risk of contrast induced nephropathy.