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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2011, Vol. 5 Issue (3) : 254-270     DOI: 10.1007/s11684-011-0153-7
REVIEW |
Multislice computed tomography angiography in the diagnosis of cardiovascular disease: 3D visualizations
Zhonghua Sun()
Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia, Australia
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Abstract  

Multislice computed tomography (CT) has been widely used in clinical practice for the diagnosis of cardiovascular disease due to its reduced invasiveness and high spatial and temporal resolution. As a reliable alternative to conventional angiography, multislice CT angiography has been recognized as the method of choice for detecting and diagnosing head and neck vascular disease, abdominal aortic aneurysm, aortic dissection, and pulmonary embolism. In patients with suspected coronary artery disease, although invasive coronary angiography still remains as the gold standard technique, multislice CT angiography demonstrates high diagnostic accuracy; in selected patients, it is considered as the first-line technique. The imaging diagnosis of cardiovascular disease is based on a combination of two-dimensional (2D) and three-dimensional (3D) visualization tools to enhance the diagnostic value. This is facilitated by reconstructed visualizations which provide additional information about the extent of the disease, an accurate assessment of the spatial relationship between normal structures and pathological changes, and pre-operative planning and post-procedure follow-up. The aim of the present article is to present an overview of the diagnostic performance of various 2D and 3D CT visualizations in cardiovascular disease, including multiplanar reformation, maximum intensity projection, volume rendering, and virtual intravascular endoscopy. The recognition of the potential value of these visualizations will assist clinicians in efficiently using the multislice CT imaging modality for the diagnostic management of patients with cardiovascular disease.

Keywords cardiovascular disease      multislice computed tomography      three-dimensional reconstruction      diagnosis      visualization     
Corresponding Authors: Sun Zhonghua,Email:z.sun@curtin.edu.au   
Issue Date: 05 September 2011
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-011-0153-7     OR     http://academic.hep.com.cn/fmd/EN/Y2011/V5/I3/254
Fig.1  2D MIP (A) and 3D VR (B) images demonstrate normal carotid arteries arising from the aortic arch with visualization of cerebral branches.
Fig.2  Sagittal reformatted CT image shows significant stenosis at the right coronary artery (A). Virtual intravascular endoscopy demonstrates narrowed arterial lumen due to the presence of plaques (arrows in B).
Fig.3  A carotid stent is implanted to treat right carotid stenosis (A). Virtual intravascular endoscopy shows the intraluminal views of carotid stent with patent lumen (arrows in B).
Fig.4  3D CT angiography demonstrates the circle of Willis with bony structures (A). Subtracted CT angiography with some bone structures removed clearly shows the artery branches in the circle of Willis (B).
Fig.5  A non-calcified coronary plaque (arrow in A) is demonstrated at the proximal segment of right coronary artery on a curved planar reformatted (CVR) image in a patient with suspected CAD. The plaque results in more than 50% coronary lumen stenosis. CVR shows mixed coronary plaques (arrows in B) at the proximal segment of left anterior descending in another patient with atypical chest pain, diabetes, and hypertension.
Fig.6  CVR shows a normal right coronary artery without any sign of plaques. PLB-posterior lateral branch.
Fig.7  Calcified coronary plaques are shown (long arrow) at the proximal segment of the left anterior descending, as well as the distal segment of left circumflex (short arrow) branches on a coronal MIP image in a patient with a history of chest pain and hypertension.
Fig.8  3D VR demonstrates the left coronary artery with excellent visualization of the normal left coronary artery and its side branches.
Fig.9  A noncalcified plaque is noticed in the proximal segment of the right coronary artery (arrow in A), and VIE shows the smooth protruding appearance arising from the inferior wall (arrows in B). Extensive calcified plaques are found in the left coronary artery with a total occlusion of midleft circumflex observed on CVR image (C) in a patient with atypical chest pain. The corresponding VIE image (D) shows significant stenosis with irregular wall change in the left coronary wall.
Fig.10  3D CT VIE shows the aortic valve with normal appearance (A). Multiplanar reformatted views indicate the viewing position placed at the outlet of the left ventricle (B). The red square refers to the virtual camera, whereas the blue square points to the virtual eye location.
Fig.11  An axial CT image shows a large aortic aneurysm with extensive artery wall calcification and large thrombus formation.
Fig.12  CVR views (A) allow for the accurate measurement of aneurysm diameter and proximal and distal aneurysm neck lengths. The 3D surface rendered image (B) shows an infrarenal aortic aneurysm that involves bilateral common iliac arteries. Coronal MIP (C) image demonstrates extensive calcification in the aneurysm wall and in the origins of the renal arteries.
Fig.13  Diagrams for the pre-operative planning of the endovascular repair of AAA. (A) A planning diagram is developed based on 3D CT reconstructions in a patient diagnosed with AAA. (B) The open view of the upper portion of the stent graft shows double width fenestration (long arrows), large fenestration (short arrow), and small fenestrations (arrowheads), which are implanted in the celiac axis, superior mesenteric artery, and renal arteries, respectively.
Fig.14  Coronal MIP (A) shows that a suprarenal stent graft is placed above the renal arteries with successful exclusion of the aneurysm. 3D VR (B) shows the relationship between the aortic stent graft and the abdominal aorta and its branches by coding different colors, such as red, yellow, and white, to the stent wires, blood vessels, and bones, respectively.
Fig.15  VIE shows that the left renal (A) and superior mesenteric artery (B) ostia are crossed by single and multiple stent wires, respectively, in a patient treated with suprarenal stent-graft. Short arrows indicate the renal and superior mesenteric ostia, whereas long arrows refer to suprarenal stent wires.
Fig.16  Coronary MIP (A) reveals the fenestrated renal stents implanted in a patient treated with fenestrated stent-graft. Corresponding VIE images show the fenestrated renal stents (B and C) with normal circular appearance. An extended intra-aortic protrusion of the left renal stent is noticed (B).
Fig.17  VIE shows the flaring effect at the inferior component of the right renal stent (arrows in A) due to balloon inflation during fenestrated stent grafting procedure and deformed right renal stent (arrows in B). Arrows indicate the intraluminal appearances of the fenestrated renal stents.
Fig.18  Sagittal reformatted images show Stanford B dissection in the descending aorta with intimal tear arising just posterior to the left subclavian artery (black arrows). The true lumen (white arrows) is much smaller than the false lumen.
Fig.19  Stanford type A dissection is limited to the ascending aorta as shown on a 2D axial image (arrow in A). Both true and false lumens are clearly demonstrated on VIE visualization, and these two lumens are separated by an intimal flap (B). The three main artery branches are perfused by the true lumen as shown on VIE view. LSA-left subclavian artery, LCA-left common carotid artery.
Fig.20  2D axial images demonstrate that multiple pulmonary emboli are present in the right main pulmonary trunk and right upper and lower lobar branches (arrows in top row images). Coronal multiplanar reformatted images provide a clear visualization of these emboli in the right pulmonary arterial branches (arrows in the bottom row images).
Fig.21  VIE shows PE involving bilateral pulmonary artery branches with a large thrombus present in the left main pulmonary artery extending to the right side. PRA-right pulmonary artery, LPA-left pulmonary artery.
Fig.22  VIE views of the left lower lobar embolism from the proximal to distal segments of the lobar artery (A, B). The accurate position of the thrombus is confirmed with multiplanar views (C).
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