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Background: We aimed to evaluate the feasibility of a non-contrast time-of-flight magnetic resonance angiography (TOF-MRA) protocol for the pre-procedural access route assessment of transcatheter aortic valve implantation (TAVI) in comparison with contrast-enhanced cardiac dual-source computed tomography angiography (CTA). Methods and Results: In total, 51 consecutive patients (mean age: 82.69 ± 5.69 years) who had undergone a pre-TAVI cardiac CTA received TOF-MRA for a pre-procedural access route assessment. The MRA image quality was rated as very good (median of 5 [IQR 4–5] on a five-point Likert scale), with only four examinations rated as non-diagnostic. The TOF-MRA systematically underestimated the minimal effective vessel diameter in comparison with CTA (for the effective vessel diameter in mm, the right common iliac artery (CIA)/external iliac artery (EIA)/common femoral artery (CFA) MRA vs. CTA was 8.04 ± 1.46 vs. 8.37 ± 1.54 (p < 0.0001) and the left CIA/EIA/CFA MRA vs. CTA was 8.07 ± 1.32 vs. 8.28 ± 1.34 (p < 0.0001)). The absolute difference between the MRA and CTA was small (for the Bland–Altman analyses in mm, the right CIA/EIA/CFA was −0.36 ± 0.77 and the left CIA/EIA/CFA was −0.25 ± 0.61). The overall correlation between the MRA and CTA measurements was very good (with a Pearson correlation coefficient of 0.87 (p < 0.0001) for the right CIA/EIA/CFA and a Pearson correlation coefficient of 0.9 (p < 0.0001) for the left CIA/EIA/CFA). The feasibility agreement between the MRA and CTA for transfemoral access was good (the right CIA/EIA/CFA agreement was 97.9% and the left CIA/EIA/CFA agreement was 95.7%, Kohen's kappa: 0.477 (p = 0.001)). Conclusions: The TOF-MRA protocol was feasible for the assessment of the access route in an all-comer pre-TAVI population. This protocol might be a reliable technique for patients at an increased risk of contrast-induced nephropathy. [ABSTRACT FROM AUTHOR]

The aim of this paper is to evaluate the diagnostic image quality of spectral dual-source photon-counting detector coronary computed tomography angiography (PCD-CCTA) for coronary artery disease in a multicenter study. The image quality (IQ), assessability, contrast-to-noise ratio (CNR), Agatston score, and radiation exposure were measured. Stenoses were quantified and compared with invasive coronary angiography, if available. A total of 92 subjects (65% male, age 58 ± 14 years) were analyzed. The prevalence of significant coronary artery disease (CAD) (stenosis ≥ 50%) was 17% of all patients, the range of the Agatston score was 0–2965 (interquartile range (IQR) 0–135). The IQ was very good (one, IQR one–two), the CNR was very high (20 ± 10), and 5% of the segments were rated non-diagnostic. The IQ and assessability were higher in proximal coronary segments (p < 0.001). Agatston scores up to 600 did not significantly affect the assessability of the coronary segments (p = 0.3). Heart rate influenced assessability only at a high-pitch mode (p = 0.009). For the invasive coronary angiography (ICA) subgroup (n = nine), the diagnostic performance for CAD per segment was high (sensitivity 92%, specificity 96%), although the limited number of patients who underwent both diagnostic modalities limits the generalization of this finding at this stage. PCD-CCTA provides good image quality for low and moderate levels of coronary calcifications. [ABSTRACT FROM AUTHOR]

(1) Background: Early hypo-attenuated leaflet thickening (HALT) is diagnosed by computed tomography angiography (CTA) in approximately 15% of patients undergoing transcatheter aortic valve replacement (TAVR). We sought to investigate the diagnostic performance of CTA for the diagnosis of HALT, focusing on timing data assessment within the cardiac cycle. (2) Methods: The study enrolled 50 patients with and 50 without HALT with available post-TAVR-CTA. The primary objective was to compare the diagnostic performance of CTA readings at specific intervals and time points during the cardiac cycle (entire systole, entire diastole, end-systole, and mid-diastole) versus gold standard (consensus reading by two observers based on multiphase full cardiac cycle data sets). (3) Results: 100 CTAs were independently analysed by two observers blinded to clinical characteristics of the study population and the results from the gold standard reading. Sensitivity and specificity for the diagnosis of HALT were 84%/94% in systole, 87%/92% in diastole, 78%/95% at end-systole, and 80%/94% at mid-diastole. End-systole had the highest positive predictive value (0.88) and positive likelihood ratio (36). Cohen's kappa for interobserver reliability was 0.715 in systole, 0.578 in diastole, 0.650 at end-systole, and 0.517 at mid-diastole. (4) Conclusion: Limiting CTA reading to distinct intervals or time points during the cardiac cycle has good specificity but lowers sensitivity. For a reliable diagnosis of HALT, data sets from a multiphase CTA covering the entire cardiac cycle should be analysed. A double reader approach would be desirable in further studies investigating HALT. [ABSTRACT FROM AUTHOR]