Transcatheter aortic valve replacement (TAVR) is a minimally invasive alternative to conventional aortic valve replacement in symptomatic patients with severe aortic stenosis and contraindications to surgery. The procedure has shown to improve patient’s quality of life and prolong short- and mid-term survival in high-risk individuals, becoming a widely accepted therapeutic option which has been integrated into current clinical guidelines for the management of valvular heart disease. Nevertheless, not every patient at high-risk for surgery is a good candidate for TAVR. Besides clinical selection, which is usually established by the Heart Team, certain technical and anatomic criteria must be met as, unlike in surgical valve replacement, annular sizing is not performed under direct surgical evaluation but on the basis of non-invasive imaging findings. Present consensus document was outlined by a working group of researchers from the European Society of Cardiovascular Radiology (ESCR) and aims to provide guidance on the utilisation of CT and MR imaging prior to TAVR. Particular relevance is given to the technical requirements and standardisation of the scanning protocols which have to be tailored to the remarkable variability of the scanners currently utilised in clinical practice; recommendations regarding all required pre-procedural measurements and medical reporting standardisation have been also outlined, in order to ensure quality and consistency of reported data and terminology. Key Points • To provide a reference document for CT and MR acquisition techniques, taking into account the significant technological variation of available scanners. • To review all relevant measurements that are required and define a step-by-step guided approach for the measurements of different structures implicated in the procedure. • To propose a CT/MR reporting template to assist in consistent communication between various sites and specialists involved in the procedural planning.

Multidetector CT angiography (CTA) has become a widely accepted examination for non-invasive evaluation of the heart and coronary arteries. Despite its ongoing success and worldwide clinical implementation, it remains an often-challenging procedure in which image quality, and hence diagnostic value, is determined by both technical and patient-related factors. Thorough knowledge of these factors is important to obtain high-quality examinations. In this review, we discuss several key elements that may adversely affect coronary CTA image quality as well as potential measures that can be taken to mitigate their impact. In addition, several recent vendor-specific advances and future directions to improve image quality are discussed.

BACKGROUND AND PURPOSE: The purpose of this work was to evaluate the possible use of low-dose multidetector CT (MDCT) in cervical clearance of patients with blunt trauma. MATERIALS AND METHODS: A total of 191 patients underwent cervical spine MDCT with 6- and 16-MDCT: standard-dose (n = 51) and low-dose MDCT with tube current modulation at high (n = 70) and low (n = 70) tube voltage (kilovolts). Effective dose, image noise, and subjective image quality were calculated in all of the patients. RESULTS: MDCT found 18 patients (9.4%) with a cervical spine fracture, 3 in the standard-dose and 15 in the low-dose group, 14 of them with unstable lesions. Tube current modulation reduced the dose by 50%–61% in all of the low-dose examinations. The mean effective dose was 3.75, 1.57, and 1.08 mSv, and mean image noise was 14.82, 17.46, and 19.72 Hounsfield units for standard dose and low dose with high and low kilovolt examinations, respectively. These differences in mean effective dose and image noise were significant between the 3 examination groups (Kruskal-Wallis test: P < .0001 and P = .0001). Evaluation of subjective image quality by 2 radiologists and 2 residents showed no significant difference in image quality score among the 3 examination groups (Kruskal-Wallis tests, P = .61, .32, .18, and .31). All of the reviewers correctly detected 18 fractures, except 1 resident, who missed 3 fractures. CONCLUSION: Low-dose cervical spine MDCT in patients with blunt trauma gives a substantial dose reduction of 61%–71%, compared with standard-dose MDCT, with a small increase in image noise and without difference in subjective image quality evaluation.

The principles of transcatheter-based therapy for aortic valve stenosis are reviewed, with emphasis on the relevant anatomy of the aortic root and the role of multidetector CT in patient selection, device size selection, and preprocedural evaluation of possible access routes. Aortic valve stenosis is the most common valvular heart disease in the Western world. When symptomatic, aortic valve stenosis is a debilitating disease with a dismal short-term prognosis, invariably leading to heart failure and death. Elective surgical valve replacement has traditionally been considered the standard of care for symptomatic aortic valve stenosis. However, several studies have identified various subgroups of patients with a significantly elevated risk for surgery-related complications and death. Thus, not every patient is a suitable candidate for surgery. Recent developments in transcatheter-based therapies have provided an alternative therapeutic strategy for the nonsurgical patient population known as transcatheter aortic valve replacement (TAVR) (also called transcatheter aortic valve implantation or percutaneous aortic valve replacement). In TAVR, the native aortic valve is replaced with a bioprosthetic valve via a nonsurgical endovascular, transaortic, or transapical pathway. Neverthel...