CT before transcatheter aortic valve replacement: Value of venous phase imaging for detection and interpretation of findings with impact on the TAVR procedure

• We analyze the incidence of nonvascular incidental findings with effect on TAVI.
• We review the value of MDCT with venous phase imaging before TAVI.
• MDCT with venous phase imaging may be considered in selected patients.

BackgroundMultidetector CT (MDCT) is performed to evaluate patients before transcatheter aortic valve replacement (TAVR). MDCT can uncover relevant nonvascular incidental findings. The use of venous phase imaging (VPI) in MDCT before TAVR has not been evaluated.ObjectiveTo evaluate the incidence of nonvascular findings in MDCT before TAVR with effect on the TAVR procedure and the value of VPI in this setting.MethodsSixty-four-slice MDCT angiography with VPI (100 mL contrast agent with 370-mg iopromide per mL) in 76 patients was retrospectively evaluated by 2 readers. Nonvascular findings were separately assessed on arterial and venous phase images and categorized in consensus as nonsignificant (no effect on TAVR), intermediate (further workup or surveillance necessary, no effect on TAVR), or significant (effect on TAVR). Radiation dose was recorded as dose-length product (DLP) and effective dose was calculated.ResultsA total of 169 findings were detected, of which 155 (91.7%) were nonsignificant, 13 (7.7%) were intermediate, and 1 (0.6%) was significant. TAVR was canceled in 1 patient (1.3%) because of suspected pancreatic cancer. No significant finding was seen on VPI only. Mean total DLP was 1137.9 mGy·cm (16.07 mSv) and the proportional mean DLP of VPI was 403 mGy·cm (6.85 mSv).ConclusionThe incidence of nonvascular significant findings in MDCT before TAVR is low and VPI in our series did not add value. However, it may be considered in selected patients.