Asymptomatic Cor Triatriatum: Utility of 64-Slice Multidetector Computed Tomography With 3-Dimensional Volume Rendering

Cinematic versus volume rendered imaging for the depiction of complex congenital heart disease

INTRODUCTION

Planning for surgical intervention for patients with complex congenital heart disease requires a comprehensive understanding of the individual's anatomy. Cinematic rendering (CR) is a novel technique that purportedly builds on traditional volume rendering (VR) by converting CT image data into clearly defined 3D reconstructions through the stimulation and propagation of light rays. The purpose of this study was to compare CR to VR for the understanding of critical anatomy in unoperated complex congenital heart disease.

METHODS

In this retrospective study, CT data sets from 20 sequential scanned cases of unoperated paediatric patients with complex congenital heart disease were included. 3D images were produced at standardised and selected orientations, matched for both VR and CR. The images were then independently reviewed by two cardiologists, two radiologists and two surgeons for overall image quality, depth perception and the visualisation of surgically relevant anatomy, the coronary arteries and the pulmonary veins.

RESULTS

Cinematic rendering demonstrated significantly superior image quality, depth perception and visualisation of surgically relevant anatomy than VR.

CONCLUSION

Cinematic rendering is a novel 3D CT-rendering technique that may surpass the traditionally used volumetric rendering technique in the provision of actionable pre-operative anatomical detail for complex congenital heart disease.

Initial experience with cinematic rendering for the visualization of extracardiac anatomy in complex congenital heart defects†

OBJECTIVES

Detailed anatomical information is essential for planning of surgical therapy in patients with congenital heart disease. We wanted to determine whether cinematic rendering, the novel 3-dimensional visualization technique, could help paediatric cardiac surgeons achieve better preoperative visualization of the extracardiac anatomy in patients with complex congenital heart defects. Therefore, cinematic rendering was compared to the traditional volume rendering technique by means of a questionnaire with predefined criteria.

METHODS

Picture sets from 20 infant patients (mean age = 17 days) were generated from computed tomography data with both the cinematic rendering and the volume rendering techniques. These were presented side by side in a digital high-resolution portfolio without labelling them. Three experienced paediatric cardiac surgeons were provided with these portfolios and a questionnaire. They were asked to evaluate the images individually in predefined categories on a 4-point Likert scale from 1 = 'fully acceptable' to 4 = 'unacceptable'.

RESULTS

Cinematic rendering scored significantly better values on the Likert scale in 7 of 9 categories, namely 'spatial impression in general', 'depth perception', 'delineation of the atrial appendages/pulmonary veins/peripheral pulmonary arteries', 'assessability of the anterior interventricular sulcus' and 'assessability of the aortic arch branches'.

CONCLUSIONS

Cinematic rendering is a valuable software tool, and our data suggest that it provides significantly better visualization than volume rendering. The surgeons appraised improved depth perception and delineation of structures adjacent to the heart as the most significant advantages.

Cardiac CT angiography beyond the coronary arteries: what radiologists need to know and why they need to know it

OBJECTIVE

With current state-of-the-art CT combining fast scanning times and high spatial resolution, anatomy beyond the coronary arteries is well visualized and may lead to discovery of abnormalities. The purpose of this article is to provide a strategy for radiologists to recognize important extracoronary cardiac CT angiography (CTA) findings.

CONCLUSION

A systemic approach to cardiac CTA by anatomic location and attention to key CT features are critical to identify and properly characterize important extracoronary cardiac abnormalities.

Evaluation of cor triatriatum dexter with use of 64-slice multidetector computed tomography

Cor triatriatum dexter, a rare condition in which the right atrium is divided by an anomalous membrane, is shown with cardiac CT, magnetic resonance imaging and direct surgical visualization.