Korean Journal of Radiology

  • 제25권7호
  • /
  • Pages.634-643
  • /
  • 2024
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Diagnostic Efficacy and Safety of Low-Contrast-Dose Dual-Energy CT in Patients With Renal Impairment Undergoing Transcatheter Aortic Valve Replacement

  • Suyon Chang (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jung Im Jung (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kyongmin Sarah Beck (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kiyuk Chang (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yaeni Kim (Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kyunghwa Han (Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine)
  • 투고 : 2023.12.02
  • 심사 : 2024.05.10
  • 발행 : 2024.07.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: This study aimed to evaluate the diagnostic efficacy and safety of low-contrast-dose, dual-source dual-energy CT before transcatheter aortic valve replacement (TAVR) in patients with compromised renal function. Materials and Methods: A total of 54 consecutive patients (female:male, 26:38; 81.9 ± 7.3 years) with reduced renal function underwent pre-TAVR dual-energy CT with a 30-mL contrast agent between June 2022 and March 2023. Monochromatic (40- and 50-keV) and conventional (120-kVp) images were reconstructed and analyzed. The subjective quality score, vascular attenuation, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were compared among the imaging techniques using the Friedman test and post-hoc analysis. Interobserver reliability for aortic annular measurement was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. The procedural outcomes and incidence of post-contrast acute kidney injury (AKI) were assessed. Results: Monochromatic images achieved diagnostic quality in all patients. The 50-keV images achieved superior vascular attenuation and CNR (P < 0.001 in all) while maintaining a similar SNR compared to conventional CT. For aortic annular measurement, the 50-keV images showed higher interobserver reliability compared to conventional CT: ICC, 0.98 vs. 0.90 for area and 0.97 vs. 0.95 for perimeter; 95% limits of agreement width, 0.63 cm2 vs. 0.92 cm2 for area and 5.78 mm vs. 8.50 mm for perimeter. The size of the implanted device matched CT-measured values in all patients, achieving a procedural success rate of 92.6%. No patient experienced a serum creatinine increase of ≥ 1.5 times baseline in the 48-72 hours following CT. However, one patient had a procedural delay due to gradual renal function deterioration. Conclusion: Low-contrast-dose imaging with 50-keV reconstruction enables precise pre-TAVR evaluation with improved image quality and minimal risk of post-contrast AKI. This approach may be an effective and safe option for pre-TAVR evaluation in patients with compromised renal function.

키워드

과제정보

The authors wish to acknowledge the financial support of the Catholic Medical Center Research Foundation made in the program year of 2023.

참고문헌

  1. Hayashida K, Bouvier E, Lefevre T, Hovasse T, Morice MC, Chevalier B, et al. Impact of CT-guided valve sizing on post-procedural aortic regurgitation in transcatheter aortic valve implantation. EuroIntervention 2012;8:546-555 
  2. Carroll JD, Mack MJ, Vemulapalli S, Herrmann HC, Gleason TG, Hanzel G, et al. STS-ACC TVT registry of transcatheter aortic valve replacement. J Am Coll Cardiol 2020;76:2492-2516 
  3. Elhmidi Y, Bleiziffer S, Deutsch MA, Krane M, Mazzitelli D, Lange R, et al. Acute kidney injury after transcatheter aortic valve implantation: incidence, predictors and impact on mortality. Arch Cardiovasc Dis 2014;107:133-139 
  4. Hibino M, Yoon SH, Dallan LAP, Pelletier MP, Rushing GD, Filby SJ, et al. Feasibility and safety of exclusive noncontrast computed tomography for planning of transcatheter aortic valve implantation with self-expandable valves. Am J Cardiol 2023;190:122-124 
  5. Suh YJ, Lee S, Hong GR, Ko YG, Hong MK, Kim YJ. Feasibility of aortic annular measurements using noncontrast-enhanced cardiac computed tomography in preprocedural evaluation of transcatheter aortic valve replacement: a comparison with contrast-enhanced computed tomography. J Comput Assist Tomogr 2022;46:50-55 
  6. Johnson TR. Dual-energy CT: general principles. AJR Am J Roentgenol 2012;199(5 Suppl):S3-S8 
  7. Yu L, Leng S, McCollough CH. Dual-energy CT-based monochromatic imaging. AJR Am J Roentgenol 2012;199(5 Suppl):S9-S15 
  8. Chang S, Han K, Youn JC, Im DJ, Kim JY, Suh YJ, et al. Utility of dual-energy CT-based monochromatic imaging in the assessment of myocardial delayed enhancement in patients with cardiomyopathy. Radiology 2018;287:442-451 
  9. Dubourg B, Caudron J, Lestrat JP, Bubenheim M, Lefebvre V, Godin M, et al. Single-source dual-energy CT angiography with reduced iodine load in patients referred for aortoiliofemoral evaluation before transcatheter aortic valve implantation: impact on image quality and radiation dose. Eur Radiol 2014;24:2659-2668 
  10. Martin SS, Albrecht MH, Wichmann JL, Husers K, Scholtz JE, Booz C, et al. Value of a noise-optimized virtual monoenergetic reconstruction technique in dual-energy CT for planning of transcatheter aortic valve replacement. Eur Radiol 2017;27:705-714 
  11. Cavallo AU, Patterson AJ, Thomas R, Alaiti MA, Attizzani GF, Laukamp K, et al. Low dose contrast CT for transcatheter aortic valve replacement assessment: results from the prospective SPECTACULAR study (spectral CT assessment prior to TAVR). J Cardiovasc Comput Tomogr 2020;14:68-74 
  12. Murray N, Darras KE, Walstra FE, Mohammed MF, McLaughlin PD, Nicolaou S. Dual-energy CT in evaluation of the acute abdomen. Radiographics 2019;39:264-286 
  13. Paul J, Bauer RW, Maentele W, Vogl TJ. Image fusion in dual energy computed tomography for detection of various anatomic structures--effect on contrast enhancement, contrast-to-noise ratio, signal-to-noise ratio and image quality. Eur J Radiol 2011;80:612-619 
  14. Kok M, Turek J, Mihl C, Reinartz SD, Gohmann RF, Nijssen EC, et al. Low contrast media volume in pre-TAVI CT examinations. Eur Radiol 2016;26:2426-2435 
  15. Spagnolo P, Giglio M, Di Marco D, Latib A, Besana F, Chieffo A, et al. Feasibility of ultra-low contrast 64-slice computed tomography angiography before transcatheter aortic valve implantation: a real-world experience. Eur Heart J Cardiovasc Imaging 2016;17:24-33 
  16. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31 
  17. Conover WJ, Iman RL. Multiple-comparisons procedures. Informal report (No. LA-7677-MS). Los Alamos: Los Alamos Scientific Lab, 1979:17 
  18. Conover WJ. Practical nonparametric statistics. 3rd ed. New York: John Wiley & Sons, 1999:367 
  19. Crimi G, De Marzo V, De Marco F, Conrotto F, Oreglia J, D'Ascenzo F, et al. Acute kidney injury after transcatheter aortic valve replacement mediates the effect of chronic kidney disease. J Am Heart Assoc 2022;11:e024589 
  20. Beohar N, Doshi D, Thourani V, Jensen H, Kodali S, Zhang F, et al. Association of transcatheter aortic valve replacement with 30-day renal function and 1-year outcomes among patients presenting with compromised baseline renal function: experience from the PARTNER 1 trial and registry. JAMA Cardiol 2017;2:742-749 
  21. Mehran R, Dangas GD, Weisbord SD. Contrast-associated acute kidney injury. N Engl J Med 2019;380:2146-2155 
  22. Parakh A, Lennartz S, An C, Rajiah P, Yeh BM, Simeone FJ, et al. Dual-energy CT images: pearls and pitfalls. Radiographics 2021;41:98-119 
  23. Van Hedent S, Grosse Hokamp N, Kessner R, Gilkeson R, Ros PR, Gupta A. Effect of virtual monoenergetic images from spectral detector computed tomography on coronary calcium blooming. J Comput Assist Tomogr 2018;42:912-918 
  24. Albrecht MH, Vogl TJ, Martin SS, Nance JW, Duguay TM, Wichmann JL, et al. Review of clinical applications for virtual monoenergetic dual-energy CT. Radiology 2019;293:260-271 
  25. Alaiti MA, Attizzani GF, Fares A, Eck B, Van Hedent S, Patel S, et al. Contrast-sparing imaging utilizing spectral detector CT for transcatheter aortic valve replacement procedure planning. Struct Heart 2020;4:195-203 
  26. Kalisz K, Rassouli N, Dhanantwari A, Jordan D, Rajiah P. Noise characteristics of virtual monoenergetic images from a novel detector-based spectral CT scanner. Eur J Radiol 2018;98:118-125 
  27. Tarkowski P, Czekajska-Chehab E. Dual-energy heart CT: beyond better angiography-review. J Clin Med 2021;10:5193 
  28. Kodzwa R. ACR manual on contrast media: 2018 updates. Radiol Technol 2019;91:97-100 
  29. Rudnick MR, Goldfarb S, Wexler L, Ludbrook PA, Murphy MJ, Halpern EF, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. Kidney Int 1995;47:254-261 
  30. Ellis JH, Khalatbari S, Yosef M, Cohan RH, Davenport MS. Influence of clinical factors on risk of contrast-induced nephrotoxicity from IV iodinated low-osmolality contrast material in patients with a low estimated glomerular filtration rate. AJR Am J Roentgenol 2019;213:W188-W193 
  31. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl 2006;100:S11-S15