RadteraCT for TAVR Planning (Cardiac + Aortoiliac)
CTA+ ContrastCardiacverify
Indications
- Pre-procedural planning for transcatheter aortic valve replacement (annulus sizing, valve selection)
- Assessment of aortic root/coronary heights, access vessel suitability
Patient prep
- 18-20G IV antecubital (consider larger for high flow)
- Renal function assessment; many TAVR patients have CKD—minimize contrast
- ECG leads; HR control usually NOT given (avoid in severe AS); nitro typically avoided
- Arms up for chest; arms can come down for vascular run if needed
Contrast
Agentiodinated (iohexol 350 / iopamidol 370)
RouteIV
Dose60-100 mL total at 4-5 mL/s; low-contrast techniques common to protect kidneys
TimingECG-gated cardiac acquisition of aortic root timed to root opacification; followed by non-gated aortoiliofemoral runoff (single injection split or separate bolus)
Technique
- Two-part protocol: (1) ECG-gated CTA of aortic root/heart for annulus measurement (systolic phase ~30-40% often preferred for annulus); (2) non-gated CTA chest/abdomen/pelvis to iliofemoral access
- Low kV (80-100 kV) and low contrast volume to limit nephrotoxicity in elderly/CKD patients
- Sub-mm collimation; reconstruct multiple cardiac phases for annulus sizing
- Annulus measured in systole at the basal ring plane on dedicated valve software
Series / Sequences
| # | Series / Sequence | Plane | Thickness | Notes |
|---|---|---|---|---|
| 1 | Gated root CTA | axial | 0.5-0.75 mm | Multiphase; annulus sizing (double-oblique basal ring) |
| 2 | Aortoiliofemoral runoff | axial | 1 mm | Access vessel diameter/calcification/tortuosity |
| 3 | Double-oblique annulus MPR | oblique | thin | Area/perimeter-derived diameter |
| 4 | 3D VR | 3D | VR | Root and access overview |
Key points
- Annulus is measured by area/perimeter in the basal ring double-oblique plane, typically in systole
- Report coronary ostial heights and sinus of Valsalva dimensions (coronary occlusion risk)
- Access vessel minimal luminal diameter and calcification determine transfemoral feasibility
- Minimize contrast (low kV, tailored volume) due to high CKD prevalence
- HR control and nitro generally avoided in severe AS
References
• SCCT Expert Consensus on CT Imaging for TAVR (JCCT)
• Radiopaedia: TAVI/TAVR CT ( link
• ACR-NASCI-SPR Practice Parameter for Cardiac CT
• Radiopaedia: TAVI/TAVR CT ( link
• ACR-NASCI-SPR Practice Parameter for Cardiac CT
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.