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Everything you need to know about Computed Tomography (CT) & CT Scanning

Colon: Cinematic Rendering and 3D Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Colon ❯ Cinematic Rendering and 3D

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  • Results There were 23 cases of mild to moderate UC and 25 cases of severe UC, which were divided into two groups. Both readers showed improved diagnostic performance with the addition of CR (the area under the ROC curve improved from 0.676 to 0.804, P = 0.0255, and from 0.679 to 0.826, P = 0.0049, for readers 1 and 2, respectively). Full view of the lesion and contrast enhancement was not significantly different between the two groups (P > 0.05). Increased mesenteric vascularity and the comb sign on CR were more clearly observed in the severe group (P < 0.05).
    Conclusion Adding CR to conventional CT improved the diagnostic performance of evaluating the extent of UC.
    Cinematic rendering: a new imaging approach for ulcerative colitis
    Jun Yang et al.
    Japanese Journal of Radiology https://doi.org/10.1007/s11604-019-00844-0
  • Purpose Cinematic rendering (CR) is a new technique for visualizing volumetric three-dimensional data. The purpose of this study was to investigate the added value of CR to conventional computed tomography (CT) in the diagnosis and evaluation of ulcerative colitis (UC).
    Conclusion Adding CR to conventional CT improved the diagnostic performance of evaluating the extent of UC.
    Cinematic rendering: a new imaging approach for ulcerative colitis
    Jun Yang et al.
    Japanese Journal of Radiology https://doi.org/10.1007/s11604-019-00844-0
  • When evaluating the images, four aspects needed to be recorded: ‘full view of the lesion’ meant the lesion was displayed at a glance in one or several images; ‘increased mesenteric vascularity’ meant the mesenteric vascularity was displayed more obviously than that of the normal state; ‘comb sign’ meant mesenteric vascular vasodilation, distortion and widening of the space of the vasa recta; and the wall contrast enhancement. Their aim was to diagnose the extent of UC (mild to moderate vs. severe) independently and then evaluate the added value of CR imaging together.
    Cinematic rendering: a new imaging approach for ulcerative colitis
    Jun Yang et al.
    Japanese Journal of Radiology https://doi.org/10.1007/s11604-019-00844-0
  • “Cinematic rendering images contain high levels of detail with shadowing and depth that are not available from traditional 3D CT techniques. As yet, the role of CR in evaluating colonic pathology has not been investigated. However, given the breadth of pathologic processes that affect the colon, including inflammatory bowel disease, diverticulitis, neoplastic conditions, herniation, and gastrointestinal bleeding, we undertook a survey of recent cases at our institution to demonstrate colon pathology as visualized with CR. The following review discusses the role of 3D CT visualizations for colonic pathology with an emphasis on CR example images.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • “Cinematic rendering makes use of volumetric data; however, it differs from the MIP and VR methods in using a global lighting model that incorporates complex path tracing and models how photons interact with the materials within the volume. This creates photorealistic images with improved surface detail relative to other 3D visualization methods. Cinematic rendering - ages are derived from standard clinical CT protocols and can be created from any volumetric CT data composed of isotropic voxels."
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • For those patients with complications or who require surgical interventions, the overall photorealistic 3D representations provided by CR may be of value in preoperative planning. Figure 4 shows such a complication in which a fistulous tract between the sigmoid colon and the urinary bladder has occurred after an episode of acute diverticulitis.
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • “As with many arterially hyperenhancing tumors, 3D visualization methods offer high-contrast resolution that allows for clear delineation of the tumor from the bowel wall and bowel contents. Relative to MIP and VR images, CR can provide greater soft tissue detail, and varying the window width and level settings can modulate the amount of other soft tissue seen relative to the hypervascular tumor, aiding in tumor visualization and potentially in surgical planning.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • Overall, the detection and characterization of tumors may be a particularly important application of CR in the colon. The potentially high contrast combined with the surface detail and shadowing from the global lighting model can make tumors stand out from background bowel wall and luminal contents. Furthermore, as we come to understand more about the implications of textural features in tumors, the visual appearance of lesions on CR may allow for prognostication regarding tumor aggressiveness.
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • Although colonoscopy, invasive angiography, and tagged red blood cell scintigraphy remain important modalities in the workup of lower gastrointestinal bleed- ing, CT angiography has recently taken on a more prominent role given that it can be performed rapidly and can often suggest underlying cause of bleeding even in patients who are not actively bleeding. For example, Figure 11 demonstrates the appearance of angiodysplasia of the cecum and proximal ascending colon discovered incidentally in a 65-year-old man being imaged for chronic abdominal pain. Note that the spatial arrangement of numerous prominent vessels within the wall of the colon and the large, early draining veins are well displayed by the CR technique.
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • “For those patients who are actively bleeding, 3D methodologies including CR provide high-contrast images on which active contrast extravasation into the bowel lumen can often be easily appreciated. Maximum intensity projection images have utility in identifying very subtle sites of active extravasation given that even a single high-density voxel may stand out, whereas VR images can be useful for evaluating the bowel wall for pathology that can lead to lower gastrointestinal bleeding. The exact role of CR in evaluating the colon for a site of bleeding has yet to be specifically identified, yet the images would seem to maintain much of the high contrast of MIPs and at the same time allow for iden- tification of soft tissue abnormalities.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • ”Indeed, a great deal of work remains to be done to validate the utility of CR images in clinical practice, although the technique is promising given the enhanced detail and realistic shadowing intrinsic to the CR methodology. In particular, the use- fulness of CR images for preoperative assessment and correlation of findings as displayed by CR relative to intraoperative experience will be of interest, and these aspects of this new visualization technique should be explored in the context of pathologies of the colon.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
  • ”CR will almost certainly be used for patient en- gagement and trainee education purposes, where the intuitive display of the relative relationships of objects within the imaged volume can aid in understanding complex anatomy and pathology. Furthermore, the global lighting model that underlies CR may prove useful for the detection and characterization of pathology, as well as after response to therapy, given its ability to accentuate different tissue types.”
    Computed Tomography Cinematic Rendering in the Evaluation of Colonic Pathology: Technique and Clinical Applications
    Steven P. Rowe, Linda C. Chu, Elliot K. Fishman,
    J Comput Assist Tomogr 2019 May/Jun;43(3):475-484
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