{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:06:27Z","timestamp":1790633187304,"version":"4.1.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T00:00:00Z","timestamp":1700265600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T00:00:00Z","timestamp":1700265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012681","name":"Universit\u00e4tsklinikum K\u00f6ln","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012681","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>This study investigated the use of dual-energy spectral detector computed tomography (CT) and virtual monoenergetic imaging (VMI) reconstructions in pre-interventional transcatheter aortic valve replacement (TAVR) planning. We aimed to determine the minimum required contrast medium (CM) amount to maintain diagnostic CT imaging quality for TAVR planning.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this prospective clinical trial, TAVR candidates received a standardized dual-layer spectral detector CT protocol. The CM amount (Iohexol 350\u00a0mg iodine\/mL, standardized flow rate 3\u00a0mL\/s) was reduced systematically after 15 patients by 10\u00a0mL, starting at 60\u00a0mL (institutional standard). We evaluated standard, and 40- and 60-keV VMI reconstructions. For image quality, we measured signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and diameters in multiple vessel sections (i.e., aortic annulus: diameter, perimeter, area; aorta\/arteries: minimal diameter). Mixed regression models (MRM), including interaction terms and clinical characteristics, were used for comparison.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Sixty consecutive patients (mean age, 79.4\u2009\u00b1\u20097.5\u00a0years; 28 females, 46.7%) were included. In pre-TAVR CT, the CM reduction to 40\u00a0mL is possible without affecting the image quality (MRM: SNR: \u20131.1, <jats:italic>p<\/jats:italic>\u2009=\u20090.726; CNR: 0.0, <jats:italic>p<\/jats:italic>\u2009=\u20090.999). VMI 40-keV reconstructions showed better results than standard reconstructions with significantly higher SNR (+\u20096.04, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Reduction to 30\u00a0mL CM resulted in a significant loss of quality (MRM: SNR: \u201312.9, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; CNR: \u201313.9, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), regardless of the reconstruction. Across the reconstructions, we observed no differences in the metric evaluation (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.914).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Among TAVR candidates undergoing pre-interventional CT at a dual-layer spectral detector system, applying 40\u00a0mL CM is sufficient to maintain diagnostic image quality. VMI 40-keV reconstructions improve the vessel attenuation and are recommended for evaluation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical relevance statement<\/jats:title>\n                <jats:p>Contrast medium reduction to 40\u00a0mL in pre-interventional transcatheter aortic valve replacement CT using dual-energy CT maintains image quality, while 40-keV virtual monoenergetic imaging reconstructions enhance vessel attenuation. These results offer valuable recommendations for interventional transcatheter aortic valve replacement evaluation and potentially improve nephroprotection in patients with compromised renal function.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p>\u2022 <jats:italic>Patients undergoing transcatheter aortic valve replacement (TAVR), requiring pre-interventional CT, are often multimorbid with impaired renal function.<\/jats:italic><\/jats:p>\n                <jats:p>\u2022 <jats:italic>Using a spectral detector dual-layer CT, contrast medium reduction to 40 mL is feasible, maintaining diagnostic image quality.<\/jats:italic><\/jats:p>\n                <jats:p>\u2022 <jats:italic>The additional application of virtual monoenergetic image reconstructions with 40 keV improves vessel attenuation significantly in clinical practice.<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-023-10403-x","type":"journal-article","created":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T08:01:36Z","timestamp":1700294496000},"page":"4089-4099","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Reduction of contrast medium for transcatheter aortic valve replacement planning using a spectral detector CT: a prospective clinical trial"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7410-0635","authenticated-orcid":false,"given":"Isabel L.","family":"Langenbach","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel C.","family":"Langenbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Mayrhofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borek","family":"Foldyna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Maintz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Klein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Wienemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin B.","family":"Krug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Hellmich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Adam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claas P.","family":"Naehle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,18]]},"reference":[{"key":"10403_CR1","doi-asserted-by":"publisher","first-page":"483","DOI":"10.4065\/mcp.2009.0706","volume":"85","author":"K Maganti","year":"2010","unstructured":"Maganti K, Rigolin VH, Sarano ME, Bonow RO (2010) Valvular heart disease: diagnosis and management. 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Langenbach, MD.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.The authors of this manuscript declare relationships with the following companies:Hendrik Wienemann has received institutional grant support from Abbott Vascular.Borek Foldyna has received unrelated research grants from the NHI\/NHLBI, AstraZeneca, Eli Lilly, and MedTrace.All other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Thomas Mayrhofer and Martin Hellmich kindly provided statistical advice for the manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all patients in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained. The HIPAA-compliant study protocol was approved by the local institutional review board (IRB) (IRB No. 21-1245, German clinical trials register DRKS00025702) as a quality assurance trial. Written informed consent was obtained before inclusion. Patients were consecutively enrolled for this prospective study between June 2021 and November 2021.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No study subjects have been previously reported.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 prospective\u2022 experimental Study\u2022 performed at one institution","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}