Understanding the Aortic Root Using Computed Tomographic Assessment: A Potential Pathway to Improved Customized Surgical Repair

There is continued interest in surgical repair of both the congenitally malformed aortic valve, and the valve with acquired dysfunction. Aortic valvar repair based on a geometric approach has demonstrated improved durability and outcomes. Such an approach requires a thorough comprehension of the complex 3-dimensional anatomy of both the normal and congenitally malformed aortic root. In this review, we provide an understanding of this anatomy based on the features that can accurately be revealed by contrast-enhanced computed tomographic imaging. We highlight the complimentary role that such imaging, with multiplanar reformatting and 3-dimensional reconstructions, can play in selection of patients, and subsequent presurgical planning for valvar repair. The technique compliments other established techniques for perioperative imaging, with echocardiography maintaining its central role in assessment, and enhances direct surgical evaluation. This additive morphological and functional information holds the potential for improving selection of patients, surgical planning, subsequent surgical repair, and hopefully the subsequent outcomes.

Image reconstruction and processing

This chapter covers all of the aspects of image reconstruction and processing, from preparation to reconstruct, methods of using back-projection, convolution filters and kernels, and iterative reconstruction techniques. It also describes the CT image matrix, numbers and windowing, image formats, and multiplanar reformatting (including curved multiplanar reformatting), maximum intensity projection, and finally 3D image formats.

Deciphering normal and anomalous viscero-atrial situs on multidetector CT angiography

Viscero-atrial situs encompasses the laterality, relative position and configuration of the abdominal viscera, the atria of the heart and the tracheobronchial tree. Determining the situs and cardiac position is the first step in the commonly used sequential, segmental approach to the imaging evaluation of congenital heart defects (CHD). Abnormalities of visceroatrial situs and cardiac position are frequently associated with the presence of complex CHDs and accurate assessment of situs abnormalities can help predict the probability and type of the defect. Multidetector CT (MDCT) angiography, with its multiplanar reformatting and volume rendering techniques, offers accurate information about the morphology and three-dimensional relationships of the various cardiac and extra cardiac structures. In this pictorial essay, we present the MDCT imaging findings of the spectrum of abnormalities of visceroatrial situs and cardiac position, using a third generation dual source CT scanner.

Possibilities of CT in the diagnosis of complications of intestinal diverticulosis (clinical observation)

Purpose. To determine the possibility of MSCT in the detection and diagnosis of complications of diverticulosis.Materials and methods. MSCT was performed in the apparatus Aqullion Toshiba 64 with collimation of 0.5–1 mm with the multiphase contrast-enhanced and further multiplanar reformatting. The results of MSCT of abdominal organs in 2082 (100%) patients for 2016–2018 in GBUZ GKB im were analyzed. M.E. Zhadkevich, 841 (40%) – for emergency indications.Results. Intestinal diverticula was detected in 239 (11%) patients. CT-signs of diverticulitis were found in 36 (1.7%) subjects: 19 (0.9%) women aged 54 years to 91 years and 17 (0.8%) men aged 27 to 88 years. When admitted to the hospital, all patients (36 people – 100%) with CT signs of diverticulitis complained of severe abdominal pain: with localization in the left iliac and suprapubic areas of 22 (61%) patients, 2 (5.5%) – in the right iliac and suprapubic areas, the remaining 12 (33.5%) patients complained of abdominal pain without a clear localization. Localization of diverticulitis in the sigmoid colon occurred in 22 (61%) cases, in the descending part of the colon – in 13 (36%). In 1 (3%) observation diverticulitis was detected in the terminal part of the jejunum.The presence of perianth infiltrate took place – in 16 (44%) cases, with signs of abscedding – in 4 (11%), peritonitis was observed in 2 (5.5%) examined in combination with signs of intestinal obstruction. Perforation with the presence of a large amount of free gas was detected in 1 (3%) case, microperforation – in 12 (33.5%). A small amount of free fluid in the abdominal cavity was found in 18 (50%) patients. Conclusion. Timely diagnosis of complicated diverticular disease is crucial. MSCT has high sensitivity and specificity in the diagnosis of phlegmon and abscesses of the abdominal cavity, perforation of the intestinal wall, peritonitis, bleeding and intestinal obstruction.

Applied Imagistics of Ischaemic Heart a Survey. From the Epidemiology of Stable Angina In Order to Better Prevent Sudden Cardiac Death

Coronary computed tomography angiography (CCTA) allows coronary artery visualization and the detection of coronary stenoses. In addition; it has been suggested as a novel, noninvasive modality for coronary atherosclerotic plaque detection, characterization, and quantification. Accurate identification of coronary plaques is challenging, especially for the noncalcified plaques, due to many factors such as the small size of coronary arteries, reconstruction artifacts caused by irregular heartbeats, beam hardening, and partial volume averaging. The development of 16, 32, 64 and the latest 320 row multidetector CT not only increases the spatial and the temporal resolution significantly, but also increases the number of images to be interpreted by radiologists substantially. Radiologists have to visually examine each coronary artery for suspicious stenosis using visualization tools such as multiplanar reformatting (MPR) and curved planar reformatting (CPR) provided by the review workstation in clinical practice

Computed Tomographic Features of Pneumothorax Secondary to a Bronchopleural Fistula in Two Dogs

A bronchopleural fistula (BPF) can lead to continuous pneumothorax and is rarely reported clinically in dogs. This report describes computed tomographic (CT) findings in two dogs with BPFs and subsequent continuous pneumothoraces that necessitated thoracotomy. Both dogs had a peripheral BPF in the right caudal lung lobe. The fistula in one dog was secondary to a previous foreign body migration, and the fistula in the other was thought to be secondary to dirofilariasis. On both CT examinations, a dilated subsegmental bronchus was seen communicating with the pleural space at the center of a focal, concave region of parenchymal consolidation. Multiplanar reformatting aided in identification and characterization of the BPF. The pneumothoraces resolved after right caudal lobectomy in both dogs. CT has the potential to identify BPFs, such as secondary to foreign body migration or dirofilariasis.

Can Computed Tomographic Gastrography and Multiplanar Reformatting Aid the Laparoscopic Surgeon in Planning a Gastric Resection? A Pictorial Essay

Purpose To assess the value and feasibility of computed tomographic gastrography and multiplanar reformatting in the preoperative evaluation of patients undergoing laparoscopic gastric resection. Materials and Methods Fourteen patients with gastric lesions were included in the study. A supine scan was performed after a hypotonic drug, an effervescent agent, and intravenous contrast. This was followed by delayed prone and decubitus scans. We created multiplanar reformats, transparency rendered images, and endoluminal images. The tumours were localized, and distances were measured to the esophagogastric junction and the pylorus. Results Eleven patients underwent resections. Seven had laparoscopic wedge resections for aberrant pancreas (1 patient), carcinoid (1), Castleman disease (1), and gastrointestinal stromal tumours (GISTs) (4). One patient had an open subtotal gastrectomy for carcinoma due to adhesions. One had a hand-assisted sleeve resection for a gastrointestinal stromal tumour. Two had hand-assisted total gastrectomies for carcinoma and a GIST. For surgical planning, the surgeon rated the imaging extremely useful in 7 and useful in 4. Imaging was extremely useful or useful to localize laparoscopically invisible tumours in 6 patients and to relate tumours to the esophagogastric junction or pylorus and to assess localized vs extensive resection in 8. Correlation was excellent between the preoperative imaging and the intraoperative findings. Conclusions Computed tomographic gastrography and multiplanar reformatting are useful aids in preoperative planning of laparoscopic gastric resections.