The Role of Cinematic Rendering in the Analysis of Complex Vascular and Mediastinal Pathology: How We Do It

The Role of Cinematic Rendering in the Analysis of Complex Vascular and Mediastinal Pathology: How We Do It

Cinematic rendering (CR) involves volumetric data alteration by application of complex mathematical modeling (Monte-Carlo simulations) based on the simulations performed on the lighting patterns of the real-life objects and the interactions of light with real life objects. This encodes information about expected lighting patterns of 3D anatomy with improved depth perception and realistic appeal to the images.

The Role of Cinematic Rendering in the Analysis of Complex Vascular and Mediastinal Pathology: How We Do It

Conventional volume rendering (VR) in comparison is a regular 3D representation of the isotropic voxel-based volume.
Cinematic Rendering is a comparative imaging post-processing technique with numerous imaging applications especially problem solving in complex cases given the depth perception, illumination patterns and delineation of anatomical relations.
These features lead to numerous applications in complex vascular and post-surgical imaging and the imaging for surgical planning and mediastinal pathology.

The Role of Cinematic Rendering in the Analysis of Complex Vascular and Mediastinal Pathology: How We Do It

Image acquisition

• Volumetric MDCT datasets
• Dual source CT scanner (Siemens FLASH and FORCE) - 256 or 384 detector row
• Bolus tracking for acquisition timing: 80-120 mL of iodinated contrast at 5-7 mL/s rate. 18G AC canula
• Collimation 0.75 x 0.5 mm

CR post-processing

• Global and local illumination patterns, with Monte Carlo simulations as described before
• Dedicated 3D workstation (syngo.via VB40, Siemens Healthineers)
• Available imaging presets + presets developed at Hopkins

How we do it!

a) CT protocol optimization – mostly Standard angiographic acquisition

• High-pitch spiral dual-source acquisitions with automated tube voltage and current selection.
• Collimation of 128 × 0.6 mm with database reconstructions at 0.75 mm slice thickness at 0.5 mm intervals.

How we do it!

b) Post processing techniques

• Dedicated workstation with 3D post-processing software with the cinematic rendering package.
• 3D CTA volumetric dataset imported into the software, manipulation using multiplanar reformatting (MPR) to produce optimal volume thickness and optimal imaging planes.
• At Hopkins we developed our own rendering parameters (i.e., color, transparency, and shading).
• Digital and manual subtraction of anatomic features can be performed

Vascular CT applications

CR has numerous applications for the interpretation of vascular pathologies, especially among complex post-surgical vascular anatomy/complications, variant anatomy or subtle findings.
1. Aortic pathologies

• Lighting model adjustments
• Trapezoid based adjustment of transparency
• Removal of intervening structures
• Dedicated imaging preset for vascular imaging

A case of coarctation of aorta is demonstrated. Notice the collaterals between the internal mammary arteries and the intercostal arteries.

Coarctation of Aorta with Collaterals

Cardiac CT

Different windowing settings or presets and alterations of the trapezoid ROI can provide different imaging contrasts to help add or remove layers based on density which can be essential for assessment of the anatomy and anomalies of the heart.
Blood pool based images can be obtained by changing presets for problem solving.
New technique called Dark blood imaging has numerous applications for cardiac CT.

A case of LVAD outflow obstruction is shown below

LVAD outflow obstruction

Cardiac CT

Valve planning CT cardiac and post-procedural imaging.

• Applications in 3D cinematic reality for interventionalists planning
• Better appreciation of anatomical relations
• Dedicated presets can be built for post procedural cases where a particular prosthetic evaluation is the question (to expedite the workflow)

Post TMVR (trans-catheter mitral valve replacement)

Post TMVR (trans-catheter mitral valve replacement)

Pericarditis

Benign pericardial cyst

Case of Hereditary Hemorrhagic Telangiectasias (HHT)

Relapsing polychondritis

Thymoma

Cystic thymoma

Advanced applications

1. Black blood Cinematic Rendering (BBCR)
A recent advancement in cardiovascular application of the cinematic rendering where a reconstruction preset is used to create dark blood images which are invaluable for luminal assessment of the heart and vessels.

Rowe SP, Chu LC, Recht HS, Lin CT, Fishman EK. Black-blood cinematic rendering: a new method for cardiac CT intraluminal visualization. Journal of cardiovascular computed tomography. 2020 May 1;14(3):272-4.

Advanced applications

2. Cinematic rendering in PET-CT dataset
A recent advancement in the field.
“CR of PET/CT data provides a photorealistic means of visualizing complex fusion imaging datasets. Such visualizations may aid anatomic understanding for surgical or procedural applications.”
Applications in cardiac PET-CT are hoped to follow.

Application of cinematic rendering in 18F-DCFPyL PSMA-targeted PET/CT demonstrating uptake in the prostate and left external iliac lymph nodes.
Rowe SP, Pomper MG, Leal JP, Schneider R, Krüger S, Chu LC, Fishman EK. Photorealistic three-dimensional visualization of fusion datasets: cinematic rendering of PET/CT. Abdominal Radiology. 2022 Aug 2:1-5.

Applications of Cinematic Rendering (CR) to cardiovascular imaging