Dr. Filippo Cademartiri

Dr. Filippo Cademartiri

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Dr. Filippo Cademartiri

@FCademartiri

13 Jun 2025

📌 CT Protocol for Pre-TAVI Planning using Dual Source CT: A Quick Refresher By Filippo Cademartiri, MD, PhD – Cardiovascular Imaging Transcatheter Aortic Valve Implantation (TAVI) has become a cornerstone treatment for aortic stenosis. DSCT CT imaging plays a crucial role in pre-procedural planning, ensuring optimal outcomes and minimizing complications. 🧭 Pre-TAVI CT Protocol 1. Patient Preparation IV access: 18–20G cannula, preferably antecubital Heart rate control: Not mandatory, but <75 bpm preferred for motion-free aortic root imaging. DSCT makes independent of Heart Rate. Breath-hold training: Essential to reduce motion artifacts 2. Scan Acquisition – One/Two Phases 🔹 A. ECG-Gated Aortic Root & Valve Assessment Type: Prospective ECG-triggered or retrospective ECG-gated Coverage: From tracheal bifurcation to diaphragm (include the entire aortic root and annulus) Phases: Typically 30–75% R-R interval (for dynamic analysis) kVp: 100–120 depending on patient size Slice thickness: 0.5/0.6 mm, overlapping reconstructions Contrast: 60–90 mL at 4 mL/s saline flush Bolus tracking: ROI in ascending aorta, trigger at 120 HU 🔹 B. Non-ECG-Gated Thoracic/Aortoiliofemoral CTA Purpose: Evaluate access route (calcification, tortuosity, vessel diameter) Slice thickness: 1 mm Reconstruction: MPR, MIP, curved MPR for iliofemoral vessels 🧠 Essential Information Extracted ✔️ Annulus diameter, perimeter, area (best measured in systole) ✔️ Sinotubular junction and coronary ostia heights ✔️ Leaflet morphology & calcification burden ✔️ LVOT characteristics ✔️ Aortic angulation ✔️ Access vessel diameters, calcifications, kinks ✔️ Tortuosity score (access route planning) 🚀 Why Dual Source CT Makes a Difference DSCT systems provide critical advantages in pre-TAVI assessment: ✅ High temporal resolution: Up to 66 ms – ideal for imaging aortic root without motion artifacts, even at higher heart rates ✅ Lower contrast dose: Thanks to faster acquisition and dual-energy capability ✅ Robust image quality: Even in arrhythmic or tachycardic patients ✅ Reduced radiation dose: With high-pitch spiral and prospective ECG triggering ✅ Simultaneous evaluation of calcium, lumen, and access with dual-energy imaging ✅ Reliable systolic phase acquisition for annular sizing (typically 30–40% R-R) 📊 Takeaway A well-structured pre-TAVI CT not only reduces procedural risks (e.g. coronary obstruction, annular rupture, vascular complications), but also improves device selection, sizing, and patient outcomes. 💬 Do you routinely use DSCT for TAVI planning? Share your protocol tips or any challenges you’ve encountered below ⬇️ #TAVI #CardiacCT #DualSourceCT #Radiology #StructuralHeart #AorticStenosis #CardiovascularImaging #ImagingProtocols #CTPlanning #StructuralIntervention #HeartTeam📌 CT Protocol for Pre-TAVI Planning using Dual Source CT: A Quick Refresher By Filippo Cademartiri, MD, PhD – Cardiovascular Imaging Transcatheter Aortic Valve Implantation (TAVI) has become a cornerstone treatment for aortic stenosis. DSCT CT imaging plays a crucial role in pre-procedural planning, ensuring optimal outcomes and minimizing complications. 🧭 Pre-TAVI CT Protocol 1. Patient Preparation IV access: 18–20G cannula, preferably antecubital Heart rate control: Not mandatory, but <75 bpm preferred for motion-free aortic root imaging. DSCT makes independent of Heart Rate. Breath-hold training: Essential to reduce motion artifacts 2. Scan Acquisition – One/Two Phases 🔹 A. ECG-Gated Aortic Root & Valve Assessment Type: Prospective ECG-triggered or retrospective ECG-gated Coverage: HEART. Phases: Typically 30–75% R-R interval (for dynamic analysis) kVp: 70–90 depending on patient size Slice thickness: 0.5/0.6 mm, overlapping reconstructions Contrast: 60–90 mL at 4 mL/s saline flush Bolus tracking: ROI in ascending aorta, trigger at 120 HU 🔹 B. Non-ECG-Gated Thoracic/Aortoiliofemoral CTA Purpose: Evaluate access route (calcification, tortuosity, vessel diameter) Slice thickness: 1 mm Reconstruction: MPR, MIP, curved MPR for iliofemoral vessels 🧠 Essential Information Extracted ✔️ Significant coronary artery stenosis ✔️ Annulus diameter, perimeter, area (best measured in systole) ✔️ Sinotubular junction and coronary ostia heights ✔️ Leaflet morphology & calcification burden ✔️ LVOT characteristics ✔️ Aortic angulation ✔️ Access vessel diameters, calcifications, kinks ✔️ Tortuosity score (access route planning) 🚀 Why Dual Source CT Makes a Difference DSCT systems provide critical advantages in pre-TAVI assessment: ✅ High temporal resolution: Up to 66 ms – ideal for imaging aortic root without motion artifacts, even at higher heart rates ✅ Lower contrast dose: Thanks to faster acquisition and dual-energy capability ✅ Robust image quality: Even in arrhythmic or tachycardic patients ✅ Reduced radiation dose: With high-pitch spiral and prospective ECG triggering ✅ Simultaneous evaluation of calcium, lumen, and access with dual-energy imaging ✅ Reliable systolic phase acquisition for annular sizing (typically 30–40% R-R) 📊 Takeaway A well-structured pre-TAVI CT not only reduces procedural risks (e.g. coronary obstruction, annular rupture, vascular complications), but also improves device selection, sizing, and patient outcomes. 💬 Do you routinely use DSCT for TAVI planning? Share your protocol tips or any challenges you’ve encountered below ⬇️ #TAVI #CardiacCT #DualSourceCT #Radiology #StructuralHeart #AorticStenosis #CardiovascularImaging #ImagingProtocols #CTPlanning #StructuralIntervention #HeartTeam