Value of a noise-optimized virtual monoenergetic reconstruction technique in dual-energy CT for planning of transcatheter aortic valve replacement

To evaluate objective and subjective image quality of a noise-optimized virtual monoenergetic imaging (VMI+) reconstruction technique in dual-energy computed tomography (DECT) angiography prior to transcatheter aortic valve replacement (TAVR). Datasets of 47 patients (35 men; 64.1 +/- 10.9 years) who underwent DECT angiography of heart and vascular access prior to TAVR were reconstructed with standard linear blending (F_0.5), VMI+, and traditional monoenergetic (VMI) algorithms in 10-keV intervals from 40-100 keV. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of 564 arterial segments were evaluated. Subjective analysis was rated by three blinded observers using a Likert scale. Mean SNR and CNR were highest in 40 keV VMI+ series (SNR, 27.8 +/- 13.0; CNR, 26.3 +/- 12.7), significantly (all p < 0.001) superior to all VMI series, which showed highest values at 70 keV (SNR, 18.5 +/- 7.6; CNR, 16.0 +/- 7.4), as well as linearly-blended F_0.5 series (SNR, 16.8 +/- 7.3; CNR, 13.6 +/- 6.9). Highest subjective image quality scores were observed for 40, 50, and 60 keV VMI+ reconstructions (all p > 0.05), significantly superior to all VMI and standard linearly-blended images (all p < 0.01). Low-keV VMI+ reconstructions significantly increase CNR and SNR compared to VMI and standard linear-blending image reconstruction and improve subjective image quality in preprocedural DECT angiography in the context of TAVR planning. aEuro cent VMI+ combines increased contrast with reduced image noise. aEuro cent VMI+ shows substantially less image noise than traditional VMI. aEuro cent 40-keV reconstructions show highest SNR/CNR of the aortic and iliofemoral access route. aEuro cent Observers overall prefer 60 keV VMI+ images. aEuro cent VMI+ DECT imaging helps improve image quality for TAVR planning.