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Small Bowel: Mpr and 3D Imaging of the Small Bowel and Mesentery Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Small Bowel ❯ MPR and 3D Imaging of the Small Bowel and Mesentery

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  • “Cinematic rendering has multiple applications in the abdomen and may serve as an important adjunct to standard CT images in the evaluation of a variety of abdominal conditions. Cinematic rendering offers the potential for comprehensive assessment of ileal NETs as it improves the appreciation of relationships between the tumor and surrounding organs, and delineation of the major vascular supply, which may influence surgical planning and help anticipate the radicality of associated ileal loop resection. Our findings provide additional evidence on the role of cinematic rendering for preoperative planning of ileal NETs compared to more traditional CT imaging.”
    Comprehensive preoperative assessment of ileal neuroendocrine tumor with cinematic rendering.  
    Pellat A, Terris B, Soyer P.  
    Diagn Interv Imaging. 2024 Jan;105(1):40-41. 
  • Cinematic rendering is a 3D reconstruction technique inspired by the animated movie industry. It follows the same steps used for volume rendering in determining colour and opacity that models real-life physical propagation of light providing photorealistic 3D images with more surface details. The application of cinematic rendering in clinical practice has been described for pre-operative planning of tumours such as GIST. Originally clinical use of 3D imaging was confined to calculating organ volumes or orthopedic applications; however, the use of helical technology for the propagation of thin slice computed tomography (CT) in conjunction with advanced image reconstruction software has allowed this to be utilized for a variety of other applications. Applications for cinematic rendering have been reported to include lesion characterization, localization, and risk stratification in the pre-operative setting.  
    Utilization of Cinematic Rendering for Evaluation of Gastrointestinal Stromal Tumours (GIST)
    Ciara O’Brien
    Canadian Association of Radiologists Journal (in press)
  • “Cinematic rendering of GIST helps demonstrate the submucosal origin of the mass and visualize the dynamic enhancement pattern within the tumour allowing for better anatomical evaluation of the lesion providing more information on areas of necrosis and enhancement. Additionally, there is increased information regarding the growth pattern, vascular supply, adjacent anatomic structures, and blood vessels which improves pre-operative planning. Active bleeding from a small bowel tumour is difficult to characterize on conventional CT. Cinematic rendering can more easily detect if there is bleeding from a small bowel tumour. It also provides increased information to differentiate GIST form other gastrointestinal tumours, especially at the ampulla and in the pelvis where anatomical detail is limited on conventional CT.”
    Utilization of Cinematic Rendering for Evaluation of Gastrointestinal Stromal Tumours (GIST)
    Ciara O’Brien
    Canadian Association of Radiologists Journal (in press)
  • “Cinematic rendering is an exciting new technique currently in its infancy that has the potential to add great value to our practice. To fulfill the advice of Dr Brady: to move forward and keep up, the next step should be to investigate how to implement cinematic rendering into our day-to-day practice.”
    Utilization of Cinematic Rendering for Evaluation of Gastrointestinal Stromal Tumours (GIST)
    Ciara O’Brien
    Canadian Association of Radiologists Journal (in press)
  • “In our own experience, 3D reconstruction methods can be invaluable for the assessment of small bowel abnormalities; in particular, the 2 most important reconstruction methods are (1) maximum intensity projection (MIP) imaging, and (2) volume rendering (VR). MIP imaging entails us- ing a computer algorithm to acquire the highest attenuation voxels in a data set and to project these high-attenuation voxels into a 3D display that can be manipulated by the radiologist. These reconstructions are invaluable in the assessment of the mesenteric vasculature (including the small second-order and third-order branch vessels, which can be visualized on the latest generations of scanners), and can accentuate vascular abnor- malities that may not be readily appreciated on the source axial images.”

    Computed Tomography Angiography of the Small Bowel and Mesentery 
Raman SP,Fishman EK
Radiol Clin N Am 54 (2016) 87–100
  • “MIP imaging entails using a computer algorithm to acquire the highest attenuation voxels in a data set and to project these high-attenuation voxels into a 3D display that can be manipulated by the radiologist. These reconstructions are invaluable in the assessment of the mesenteric vasculature (including the small second-order and third-order branch vessels, which can be visualized on the latest generations of scanners), and can accentuate vascular abnormalities that may not be readily appreciated on the source axial images.”


    Computed Tomography Angiography of the Small Bowel and Mesentery 
Raman SP,Fishman EK
Radiol Clin N Am 54 (2016) 87–100
  • “VR is a much more computationally complex process (it is beyond the scope of this article) but, in simple terms, it involves using a computer algorithm to assign a specific color and transparency to each voxel in a data set based on both its attenuation and its relationship to adjacent voxels, and then using this information to create an interactive 3D display. VR techniques are more valuable for assessing the bowel wall itself (rather than the vasculature), and can nicely show the 3D relationships of adjacent organs and structures.”

    Computed Tomography Angiography of the Small Bowel and Mesentery 
Raman SP,Fishman EK
Radiol Clin N Am 54 (2016) 87–100
  • “Fast scanning along with high resolution of multidetector computed tomography (MDCT) have expanded the role of non-invasive imaging of splanchnic arteries. Advancements in both MDCT scanner technology and three-dimensional (3D) imaging software provide a unique opportunity for non-invasive investigation of splanchnic arteries. Although standard axial computed tomography (CT) images allow identification of splanchnic arteries, visualization of small or distal branches is often limited. Similarly, a comprehensive assessment of the complex anatomy of splanchnic arteries is often beyond the reach of axial images.”
    Three-dimensional MDCT angiography of splanchnic arteries: Pearls and pitfalls.
    Dohan A et al.
    Diagn Interv Imaging. 2014 Jun 30. pii: S2211-5684(14)00202-2. doi: 10.1016/j.diii.2014.06.011. [Epub ahead of print
  •  “However, the submillimeter collimation that can be achieved with MDCT scanners now allows the acquisition of true isotropic data so that a high spatial resolution is now maintained in any imaging plane and in 3D mode. This ability to visualize the complex network of splanchnic arteries using 3D rendering and multiplanar reconstruction is of major importance for an optimal analysis in many situations.”
    Three-dimensional MDCT angiography of splanchnic arteries: Pearls and pitfalls.
    Dohan A et al.
    Diagn Interv Imaging. 2014 Jun 30. pii: S2211-5684(14)00202-2. doi: 10.1016/j.diii.2014.06.011. [Epub ahead of print
  • “Fast scanning along with high resolution of multidetector computed tomography (MDCT) have expanded the role of non-invasive imaging of splanchnic arteries. Advancements in both MDCT scanner technology and three-dimensional (3D) imaging software provide a unique opportunity for non-invasive investigation of splanchnic arteries. Although standard axial computed tomography (CT) images allow identification of splanchnic arteries, visualization of small or distal branches is often limited. Similarly, a comprehensive assessment of the complex anatomy of splanchnic arteries is often beyond the reach of axial images.”
    Three-dimensional MDCT angiography of splanchnic arteries: Pearls and pitfalls.
    Dohan A et al.
    Diagn Interv Imaging. 2014 Jun 30. pii: S2211-5684(14)00202-2. doi: 10.1016/j.diii.2014.06.011. [Epub ahead of print
  •  “However, the submillimeter collimation that can be achieved with MDCT scanners now allows the acquisition of true isotropic data so that a high spatial resolution is now maintained in any imaging plane and in 3D mode. This ability to visualize the complex network of splanchnic arteries using 3D rendering and multiplanar reconstruction is of major importance for an optimal analysis in many situations.”
    Three-dimensional MDCT angiography of splanchnic arteries: Pearls and pitfalls.
    Dohan A et al.
    Diagn Interv Imaging. 2014 Jun 30. pii: S2211-5684(14)00202-2. doi: 10.1016/j.diii.2014.06.011. [Epub ahead of print
  • Normal Anatomy
    Small Bowel
    - < 2.5 cm in diameter
    - Bowel wall < 3mm: almost imperceptible when distended
    - Thin regular folds
    - Homogeneous enhancement
  • “Surgeons considered the coronal images more informative as compared with the axial images in 76.6% of cases.”
    Small Bowel Obstruction: The Value of Coronal Reformatted Images from 16-Multidetector Computed Tomography-A Clinicoradiological Perspective
    Shah ZK et al.
    J Comput Assist Tomogr 2008;32:23-31
  • “ Coronal images generated at the scanner console are complementary to axials and improve reader confidence. Surgeons find coronal images more helpful than axial images for management.”
    Small Bowel Obstruction: The Value of Coronal Reformatted Images from 16-Multidetector Computed Tomography-A Clinicoradiological Perspective
    Shah ZK et al.
    J Comput Assist Tomogr 2008;32:23-31
  • “ In comparison with axial image display and 2D multiplanar reformatting, 3D volume rendering adds incremental value when evaluating the small bowel mesentery because of the complex anatomic configuration.”
     Nonvascular Mesenteric Disease: Utility of Multidetector CT with 3D Volume Rendering
    Johnson PT, Horton KM, Fishman EK
    RadioGraphics 2009; 29:721-740
  • Associated Abnormalities of the Mesentery and Vessels

    Mesenteric nodes 
    - Low density nodes
    - Mesenteric mass 

    SMA and SMV
    - Vessel stenosis
    - Vessel occlusion or thrombosis 

    - Location of wall involvement

     

  • "In comparison with axial image display and 2D multiplanar reformatting, 3D volume rendering adds incremental value when evaluating the small bowel mesentery because of the complex anatomic configuration."

    Nonvascular Mesenteric Disease: Utility of Multidetector CT with 3D Volume Rendering
    Johnson PT, Horton KM, Fishman EK
    RadioGraphics 2009; 29:721-740

  • "The anatomy of the small bowel mesentery is difficult to fully appreciate on the basis of a review of axial images alone. The ability to review CT image data in three dimensions facilitates an understanding of the noormal anatomy and helps characterize the scope of pathologic processes in this region."

    Nonvascular Mesenteric Disease: Utility of Multidetector CT with 3D Volume Rendering
    Johnson PT, Horton KM, Fishman EK
    RadioGraphics 2009; 29:721-740

  • "The anatomy of the small bowel mesentery is difficult to fully appreciate on the basis of a review of axial images alone. The ability to review CT image data in three dimensions facilitates an understanding of the noormal anatomy and helps characterize the scope of pathologic processes in this region."

    Nonvascular Mesenteric Disease: Utility of Multidetector CT with 3D Volume Rendering
    Johnson PT, Horton KM, Fishman EK
    RadioGraphics 2009; 29:721-740

  • "Interactive interpretation of multidetector CT data sets with volume rendering can help characterize nonvascular mesenteric disease, elucidate its extent through more comprehensive display, and facilitate the identification of complications."

    Nonvascular Mesenteric Disease: Utility of Multidetector CT with 3D Volume Rendering
    Johnson PT, Horton KM, Fishman EK
    RadioGraphics 2009; 29:721-740

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