COMPARATIVE EFFECTIVENESS OF SEMIAUTOMATED AND MANUAL CT ANALYSIS IN PLANNING OF TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH
CRITICAL AORTIC STENOSIS AND COMPLEX AORTIC ROOT ANATOMY
Gafsi B.E.¹, Fedotenkov I.S.², Shirkin A.V.², Imaev T.E.²
1 – Sechenov University.
2 – E.I. Chazov National Medical Research Center of Cardiology. Moscow, Russia.
Purpose. To evaluate the comparative analysis of manual and semi-automatic CT analysis methods and the impact of these methods on the clinical decision-making process regarding the choice of a prosthesis for transcatheter aortic valve implantation.
Materials and methods. A total of 168 patients with severe aortic stenosis were studied. They were hospitalized between October 2022 and October 2023 at the E.I. Chazov National Medical Research Center of Cardiology and Surgery for transcatheter aortic valve implantation. All patients underwent echocardiography and CT aortography, which were used to determine the surgical approach. Preoperative CT aortography revealed complex aortic root anatomy in 30 patients, requiring a more in-depth and individualized approach to data interpretation by radiologists and cardiovascular surgeons. As part of the preoperative preparation for transcatheter aortic valve implantation, parameters such as perimeter, area, diameters of the fibrous ring, sinuses of Valsalva, and left ventricular outflow tract were assessed using CT data using manual measurements and semi-automated software (Vitrea, Canon).
Preoperative work-up included echocardiography and ECG-gated CT angiography. Key annular dimensions (perimeter, area, diameters of the aortic valve annulus, sinuses of Valsalva, left ventricular outflow tract) were measured independently using traditional manual techniques and a semi-automatic software platform (Vitrea, Canon). Measurement times and values were compared.
Results. When evaluating manual and semiautomated CT analysis methods, minimal differences (1.5-3.4% for key annular parameters) in measurement results were observed. The time required for CT analysis was less, using the semiautomated method for assessing aortic root parameters.
Discussion. This study presents the comparative effectiveness of semiautomated and manual CT image analysis in planning transcatheter aortic valve implantation in a patient with critical aortic stenosis, severe valve calcification, and ellipsoidal annulus deformity.
Our study identified statistically significant but clinically insignificant discrepancies (1.5-3.4%) for most parameters when evaluating CT images using manual and semiautomated methods. Furthermore, image analysis time reduced, using semiautomated analysis. Based on this comprehensive assessment, a self-expanding graft was selected, and implantation was successful, without paraprosthetic regurgitation or conduction disturbances.
The obtained data demonstrate a high correlation between the aortic root analysis methods. A slight underestimation of the dimensions with semiautomated analysis may be due to more accurate delineation of the structural boundaries, eliminating partial volume artifacts from calcium. This confirms the feasibility of integrating semiautomated instruments into clinical practice to improve efficiency, especially during mass screenings. However, the final decision on the prosthesis size requires expert evaluation by a radiologist and cardiac surgeon, taking into account all anatomical nuances.
Conclusion. Semiautomated analysis of aortic root CT images in patients undergoing transcatheter aortic valve implantation is an accurate, reproducible, and less time-consuming method compared to manual measurements. This semiautomated method can serve as a reliable tool for screening and initial preoperative planning, including in patients with complex aortic root anatomy and severe aortic valve calcification.
Keywords: transcatheter aortic valve implantation (TAVI), computed tomography, preoperative planning, aortic stenosis, semi-automatic analysis, aortic root.
Corresponding author: Gafsi B.E., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Gafsi B.E., Fedotenkov I.S., Shirkin A.V., Imaev T.E. Comparative effectiveness of semiautomated and manual CT analysis in planning of transcatheter aortic valve implantation in patients with critical aortic stenosis and complex aortic root anatomy. REJR 2026; 16(1):34-41. DOI: 10.21569/2222-7415-2026-16-1-34-41.
Received: 26.03.26 Accepted: 14.04.26