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The aim of this study was to evaluate contrast agent-reduced CT protocols for transcatheter aortic valve reconstruction (TAVR) planning in photon counting detector CT (PCDCT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>162 BMI-matched examinations with standard dose contrast media (SCD; 80\u2009mL; Iohexol 300\u2009mg\/mL; 81 examinations) and reduced contrast media dose (RCD; 50\u2009mL; 81 examinations) for TAVR planning on a PCDCT were included in this retrospective monocentric study. Virtual monoenergetic reconstructions (VMI) at 70\u2009keV, 60\u2009keV and 50\u2009keV of contrast agent-reduced examinations were compared with polyenergetic images. Quantitatively, regions-of-interest (ROIs) were placed in the abdominal aorta, iliac bifurcation, femoral artery, left ventricle and trapezius muscles. Signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) were calculated. Qualitatively, diagnostic quality and contrast were assessed on a visual grading scale of 1 (non-diagnostic) \u2013 5 (excellent) and contrast agent dose was estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Averaged, SNR and CNR decreased by 8.71% and 16.78%, respectively, on PCDCT with reduced contrast dose (RCD vs. SCD; both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). VMI50keV increased SNR by 44.10% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and CNR by 52.73% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) compared with SCD. In the ascending aorta, SNR increased from 19.80\u2009\u00b1\u20096.24 (SCD) to 35.78\u2009\u00b1\u200913.20 (RCD\n                      <jats:sub>VMI50keV<\/jats:sub>\n                      ) and CNR from 18.84\u2009\u00b1\u20097.78 to 29.77\u2009\u00b1\u200916.70. Median contrast intensity was 5 for SCD, 4 for RCD\n                      <jats:sub>CR<\/jats:sub>\n                      , and 5 for RCD\n                      <jats:sub>VMI50keV<\/jats:sub>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The diagnostic efficacy of TAVR planning assessment using PCDCT with minimized contrast agent dosing is preserved, presenting a practical approach to conserve contrast media.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The aim of the study was to implement a PCDCT-adapted contrast media dose protocol to reduce contrast agent volume at sufficient diagnostic quality.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>PCDCT enables substantial contrast dose reduction for TAVR planning with maintained diagnostic image quality. Low-keV virtual monoenergetic image reconstructions compensate for the reduced iodine concentration.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The study demonstrates the potential of contrast media reduction of PCD-CT in clinical routine. This can benefit patients with renal impairment, for example, and reduce the negative effects of iodinated contrast media on the environment.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12613-5","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T17:56:11Z","timestamp":1778090171000},"page":"7095-7104","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Photon counting detector CT contrast agent-reduced transcatheter aortic valve reconstruction planning: a comparative study"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2379-3352","authenticated-orcid":false,"given":"Yannik C.","family":"Layer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Isaak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narine","family":"Mesropyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick A.","family":"Kupczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dmitrij","family":"Kravchenko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilia","family":"Voigt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Dell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian A.","family":"Luetkens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kuetting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"12613_CR1","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1016\/j.jacc.2012.01.001","volume":"59","author":"DR Holmes","year":"2012","unstructured":"Holmes DR, Mack MJ, Kaul S et al (2012) 2012 ACCF\/AATS\/SCAI\/STS expert consensus document on transcatheter aortic valve replacement. 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The other authors declare that there are no conflicts of interest.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No complex statistical methods were necessary for this paper.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was obtained. This study was reviewed and approved by the Ethics Committee of the Medical Faculty of Bonn with the approval number 027\/23. 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