Hereditary Hemorrhagic Telangiectasia: Cinematic Rendering of Hepatic Arteriovenous Malformations.
Radiology. 2018 Aug;288(2):341. doi: 10.1148/radiol.2018180380. Epub 2018 Jun 19. Johnson PT1, Fishman EK1.
A 50-year-old woman presented for evaluation of hereditary hemorrhagic telangiectasia (HHT), precipitated by the recent diagnosis in her father. On review of systems and physical examination, history of epistaxis and presence of telangiectasias contributed a definitive diagnosis according to Curacao diagnostic criteria. CT angiography of chest, abdomen, and pelvis was ordered to evaluate for visceral arteriovenous malformations. (a) Coronal maximum intensity projection (MIP) rendering from arterial-phase intravenous contrast–enhanced multidetector CT shows innumerable small arteriovenous malformations in the liver as well as dilatation of the hepatic artery reflecting increased perfusion. MIP renderings can elucidate small vascular structures better than three-dimensional (3D) volume rendering, but the 3D relationships of the vasculature are not maintained. (b) Coronal cinematic rendering of arterial-phase intravenous contrast–enhanced multidetector CT scan. Small arteriovenous malformations are demonstrated throughout the liver while maintaining the 3D relationships of the solid organs and vasculature. The additional detail provided by cinematic rendering combines the contrast and spatial resolution of MIP with the depth perception delivered by volume rendering.