Hyperrealistic Rendering of Type II Endoleak.

Abstract

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologyHyperrealistic Rendering of Type II EndoleakBaolei Guo , Liying PengBaolei Guo , Liying PengAuthor AffiliationsFrom the Department of Vascular Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai 200032, China (B.G.); and Central Research Institute, United Imaging Healthcare, Shanghai, China (L.P.).Address correspondence to B.G. (email: [email protected]).Baolei Guo Liying PengPublished Online:Feb 14 2023https://doi.org/10.1148/radiol.222150MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.A 71-year-old man with a history of abdominal aortic aneurysm status after endovascular aortic repair (EVAR) presented for follow-up CT angiography (CTA) at 19 months. Hyperrealistic rendering (HRR) (United Imaging Healthcare) visually demonstrated an enlarged aneurysm sac measuring 7.2 cm in maximum diameter (previously 6.1 cm, before EVAR), with type II endoleaks involving the bilateral L4 lumbar arteries and the inferior mesenteric artery (Figure, Figure S1, Movie). The patient was admitted to the hospital and underwent embolization of the aforementioned feeding vessels. Follow-up CTA at 6 months after the embolization procedure showed complete thrombosis of the aneurysm sac with no residual endoleak.Images in a 71-year-old man diagnosed with type II endoleak 19 months after the endovascular aortic repair for an abdominal aortic aneurysm. The hyperrealistic rendering from CT angiography provides a clear representation of the endoleak (black arrows) and the three major feeding vessels (white arrows) (ie, bilateral lumbar arteries [LA] and the inferior mesenteric artery [IMA]). (A) The hyperrealistic rendering in posterior view demonstrates the feeding lumbar arteries and the associated iliolumbar-lumbar pathway arising from the internal iliac arteries. (B) The hyperrealistic rendering in anterior view reveals a pathway from the superior mesenteric artery to the inferior mesenteric artery by means of the arc of Riolan feeding into the aneurysm sac (shown as a semitransparent cavity).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie: Hyper-realistic rendering from CT angiography in a 71-year-old man diagnosed with type II endoleak.Download Original Video (97.3 MB)Endoleaks, in particular type II endoleaks defined as aneurysm sac backfilling from aortic branches (1), are the most common complications of EVAR and pose persistent risk of aortic rupture. Visualization of the inflow vessels is crucial for preoperative planning. As an advanced three-dimensional visualization technique with use of physically based volume rendering, HRR can generate photorealistic images with enhanced display of complex spatial relationships and lifelike surface details. By assisting proceduralists in identifying the endoleak feeding vessels, HRR provides value in developing treatment strategies.Disclosures of conflicts of interest: B.G. No relevant relationships. L.P. No relevant relationships.Supported by the National Natural Science Foundation of China (grant 82000436) and the Science and Technology Commission of Shanghai Municipality (grants 201409004800 and 21410710500).Reference1. Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg 2002;35(5):1029–1035. Crossref, Medline, Google ScholarArticle HistoryReceived: Aug 29 2022Revision requested: Oct 10 2022Revision received: Oct 21 2022Accepted: Oct 31 2022Published online: Feb 14 2023 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Recently Published Supplemental MaterialMetrics Altmetric Score PDF download