Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan-Feb;18(1):50-55.
doi: 10.1016/j.jcct.2023.10.007. Epub 2023 Oct 28.

Diagnostic accuracy of virtual non-contrast CT for aortic valve stenosis severity evaluation

Daniel Lorenzatti  1 , Pamela Piña  2 , Jonathan Daich  1 , Andrea Scotti  1 , Javier Perez-Cervera  3 , Rita Miranda  1 , Ari J Feinberg  1 , Sandra S Halliburton  4 , Thomas B Ivanc  4 , Aldo L Schenone  1 , Toshiki Kuno  1 , Azeem Latib  1 , Damini Dey  5 , Philippe Pibarot  6 , Marc R Dweck  7 , Mario J Garcia  1 , Leandro Slipczuk  8
Affiliations

Diagnostic accuracy of virtual non-contrast CT for aortic valve stenosis severity evaluation

Daniel Lorenzatti et al. J Cardiovasc Comput Tomogr. 2024 Jan-Feb.

Abstract

Background: Computed tomography aortic valve calcium (AVC) score has accepted value for diagnosing and predicting outcomes in aortic stenosis (AS). Multi-energy CT (MECT) allows virtual non-contrast (VNC) reconstructions from contrast scans. We aim to compare the VNC-AVC score to the true non-contrast (TNC)-AVC score for assessing AS severity.

Methods: We prospectively included patients undergoing a MECT for transcatheter aortic valve replacement (TAVR) planning. TNC-AVC was acquired before contrast, and VNC-AVC was derived from a retrospectively gated contrast-enhanced scan. The Agatston scoring method was used for quantification, and linear regression analysis to derive adjusted-VNC values.

Results: Among 109 patients (55% female) included, 43% had concordant severe and 14% concordant moderate AS. TNC scan median dose-length product was 116 ​mGy∗cm. The median TNC-AVC was 2,107 AU (1,093-3,372), while VNC-AVC was 1,835 AU (1293-2,972) after applying the coefficient (1.46) and constant (743) terms. A strong correlation was demonstrated between methods (r ​= ​0.93; p ​< ​0.001). Using accepted thresholds (>1,300 AU for women and >2,000 AU for men), 65% (n ​= ​71) of patients had severe AS by TNC-AVC and 67% (n ​= ​73) by adjusted-VNC-AVC. After estimating thresholds for adjusted-VNC (>1,564 AU for women and >2,375 AU for men), 56% (n ​= ​61) had severe AS, demonstrating substantial agreement with TNC-AVC (κ ​= ​0.77).

Conclusions: MECT-derived VNC-AVC showed a strong correlation with TNC-AVC. After adjustment, VNC-AVC demonstrated substantial agreement with TNC-AVC, potentially eliminating the requirement for an additional scan and enabling reductions in both radiation exposure and acquisition time.

Keywords: Aortic stenosis; Calcium score; Dual-energy CT; Multi-energy CT; Spectral CT; Transcatheter aortic valve replacement; Virtual non-contrast.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest L.S. has received consulting honorarium from Amgen, BMS and Philips; and grant support from Amgen and Philips. D. L and P.P are supported by grants from Amgen and Philips. D.D. have received software royalties from Cedars-Sinai Medical Center. D.D. was supported by grants from National Heart, Lung and Blood institute (1R01HL133616 and 1R01HL148787-01A1). S.S.H. is an employee of Philips Healthcare. Other authors declare no conflict.