Mandibular Fracture

Multiple Facial Fractures

VR vs. CR: multiple facial and mandibular fractures

Polyostotic Fibrous Dysplasia

The profound deformation of the right orbit is best appreciated on the cinematic renderings in the lower right due to the realistic shadowing effects created by this method

Gunshot Wound with Extensive Facial Fractures

The extensive comminution of the fractures and their relative positions are easily appreciated with CR

Cinematic Vs. Volume Rendering for Soft Tissue Evaluation

The ultra-high surface detail that is possible with cinematic rendering can highlight tendons extremely reliably – thus cinematic rendering may play an adjunct role to, or even replace, MRI in certain situations such as the emergency room setting.

Rowe SP, Fritz J, Fishman EK. Emerg Radiol. 2017; Ahead of print.

Tibial Plateau and Fibular Fractures

Photorealistic depictions of complex fractures may aid surgeons in pre-operative planning

Rowe SP, Fritz J, Fishman EK. Emerg Radiol. 2017; Ahead of print.

Soft Tissue Injuries are Well-Delineated by Cinematic Rendering

Soft tissue injuries (red arrows), vascular injuries (red arrowheads), and bone structures are all well-shown by CR

Rowe SP, Fritz J, Fishman EK. Emerg Radiol. 2017; Ahead of print.

Right Hip Fracture-Dislocation

The displaced position of the posterior aspect of the right femoral head is well appreciated on the CR images; note also the realistic shadowing associated with the fractured portion of the femoral head that remains in the acetabulum (red arrow)

Femoral Neck Fracture

Hip Dysplasia

Ballistic Fracture of the Humerus

The subtle bullet hole in the soft tissues that caused this non-subtle extensively comminuted left humerus fracture can be appreciated in the top panels (red arrows)

Radial Head Fracture and Elbow Joint Dislocation

Stab Injury

No major vascular or bone injury is appreciated; however the soft tissue injury to the biceps musculature with packing material is clearly delineated (red arrows)

Distal Radius Fracture

Ankle Joint Dislocation with Fibula Fracture

Dermatomyositis with Soft Tissue Calcifications

Dermatomyositis with Soft Tissue Calcifications

Coronary Artery to Pulmonary Artery Fistula

Ductus Diverticulum – Potential Pitfall for an Acute Aortic Injury

Ductus Diverticulum – Potential Pitfall for an Acute Aortic Injury

Note how in the image in the lower left that overlying vessels and other structures can obscure the light source and prevent visualization of the pathology

Ductus Diverticulum – Potential Pitfall for an Acute Aortic Injury

Ductus diverticula can acquire a number of different shapes, complicating the interpretation of these stuctures

Acute Aortic Injury

Note the acute angles (red arrowheads) between the aorta and this lesion, indicating it is a true acute aortic injury and not a ductus diverticulum

Normal Anatomy: Highly Detailed View of the Left Atrial Appendage

Approximately 50% Stenosis in the LAD

An LAD stenosis is identified (red arrows), but can be obscured with cinematic rendering (red arrowheads) if the operator does not carefully examine the volumetric data from a variety of different views and with varying widow widths/levels and transparency settings

Intracardiac Spindle Cell Tumor

Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysm

Relative to the VR images on the previous slide, these CR images provide more realistic shadowing effects that create depth in the image that may be helpful when surgeons are planning a necessary intervention

Peripheral Vascular Grafts in a Patient with Loeys-Dietz Syndrome

Renal Artery Fibromuscular Dysplasia

The ability of including or excluding soft tissue during CR can allow for very high contrast such as can be seen in the right renal artery with fibromuscular dysplasia (red arrows), particularly in the bottom right panel

Distal Aortic Occlusion with Collateral Vessel Formation

Distal Aortic Occlusion with Collateral Vessel Formation

Right Kidney Xanthogranulomatous Pyelonephritis

Note the staghorn calculus in the renal pelvis with multiple additional stones layering in the dilated/cystic calyces

Bilateral Staghorn Calculi

Bilateral Asymptomatic Ureteropelvic Junction Obstructions

Ureteropelvic Junction Obstruction Due to Crossing Vessel

Ureticopelvic Junction Obstruction Due to Crossing Vessel

The crossing vessel (red arrow) that has lead to the UPJ obstruction is visible with both VR and CR

Cross-Fused Renal Ectopia

Crohn’s Disease with the Comb Sign

Long-standing inflammatory bowel disease can manifest increased mesenteric vasculature (the comb sign, red arrows), which is well appreciated on 3D images such as on CR

Upper Gastrointestinal Hemorrhage

Active hemorrhage (red arrows) at site of prior gastro-jejunostomy

Volvulus with Small Bowel Obstruction

Note both the swirled appearance of the mesenteric vasculature (red arrows) as well as the massively dilated loops of obstructed small bowel

Cirrhosis with Recanalized Umbilical Vein and Ascites

Future Directions

Future Directions

References and Further Reading