To compare the diagnostic value of ultrahigh-resolution CT-angiography (UHR-CTA) compared with high-pitch spiral CTA (HPS-CTA) using a first-generation, dual-source photon-counting CT (PCD-CT) scanner for preprocedural planning of transcatheter aortic valve replacement (TAVR). Clinically referred patients with severe aortic valve stenosis underwent both, retrospective ECG-gated cardiac UHR-CTA (collimation: 120 × 0.2 mm) and prospective ECG-triggered aortoiliac HPS-CTA (collimation: 144 × 0.4 mm, full spectral capabilities) for TAVR planning from August 2022 to March 2023. Radiation dose was extracted from the CT reports, and the effective dose was calculated. Two radiologists analyzed UHR-CTA and HPS-CTA datasets, assessing the image quality of the aortic annulus, with regard to the lumen visibility and margin delineation using a 4-point visual-grading scale (ranges: 4 = ”excellent” to 1 = ”poor”). Aortic annulus area (AAA) measurements were taken for valve prosthesis sizing, with retrospective UHR-CTA serving as reference standard. A total of 64 patients were included (mean age, 81 years ± 7 SD; 28 women) in this retrospective study. HPS-CTA showed a lower radiation dose, 4.1 mSv vs. 12.6 mSv (p < 0.001). UHR-CTA demonstrated higher image quality to HPS-CTA (median score, 4 [IQR, 3–4] vs. 3 [IQR, 2–3]; p < 0.001). Quantitative assessments of AAA from both CTA datasets were strongly positively correlated (mean 477.4 ± 91.1 mm² on UHR-CTA and mean 476.5 ± 90.4 mm² on HPS-CTA, Pearson r² = 0.857, p < 0.001) with a mean error of 22.3 ± 24.6 mm² and resulted in identical valve prosthesis sizing in the majority of patients (91%). Patients with lower image quality on HPS-CTA (score value 1 or 2, n = 28) were more likely to receive different sizing recommendations (82%). Both UHR-CTA and HPS-CTA acquisitions using photon-counting CT technology provided reliable aortic annular assessments for TAVR planning. While UHR-CTA offers superior image quality, HPS-CTA is associated with lower radiation exposure. However, severely impaired image quality on HPS-CTA may impact on prosthesis sizing, suggesting that immediate post-scan image evaluations may require complementary UHR-CTA scanning.

比较超高分辨率 CT 血管造影 (UHR-CTA) 与使用第一代双源光子计数 CT (PCD-CT) 扫描仪进行术前检查的高螺距螺旋 CTA (HPS-CTA) 的诊断价值经导管主动脉瓣置换术（TAVR）的规划。临床转诊的严重主动脉瓣狭窄患者接受了回顾性心电图门控心脏 UHR-CTA（准直：120 × 0.2 mm）和前瞻性心电图触发主动脉髂 HPS-CTA（准直：144 × 0.4 mm，全光谱功能）进行 TAVR规划时间为2022年8月至2023年3月。从CT报告中提取辐射剂量，计算有效剂量。两名放射科医生分析了 UHR-CTA 和 HPS-CTA 数据集，使用 4 点视觉分级量表（范围：4 =“优秀”至 1 = “贫穷的”）。主动脉瓣环面积 (AAA) 测量用于确定瓣膜假体尺寸，并以回顾性 UHR-CTA 作为参考标准。本回顾性研究共纳入 64 名患者（平均年龄 81 岁 ± 7 SD；28 名女性）。 HPS-CTA 显示出较低的辐射剂量，分别为 4.1 mSv 与 12.6 mSv (p < 0.001)。 UHR-CTA 表现出比 HPS-CTA 更高的图像质量（中位评分，4 [IQR，3–4] 与 3 [IQR，2–3]；p < 0.001）。两个 CTA 数据集的 AAA 定量评估呈强正相关（UHR-CTA 上的平均值为 477.4 ± 91.1 mm ² ，HPS-CTA 上的平均值为 476.5 ± 90.4 mm ² ，Pearson r ² = 0.857，p < 0.001），平均误差为22.3 ± 24.6 mm ² ，大多数患者 (91%) 的瓣膜假体尺寸相同。 HPS-CTA 图像质量较低的患者（评分值 1 或 2，n = 28）更有可能接受不同的尺寸建议 (82%)。使用光子计数 CT 技术的 UHR-CTA 和 HPS-CTA 采集为 TAVR 规划提供了可靠的主动脉环评估。 UHR-CTA 提供卓越的图像质量，而 HPS-CTA 则具有较低的辐射暴露。然而，HPS-CTA 上的图像质量严重受损可能会影响假体尺寸，这表明扫描后立即进行图像评估可能需要补充 UHR-CTA 扫描。