Slab Maximum Intensity Projection Research Articles

A simple mathematical method to identify optimal biplane fluoroscopic angulations for chronic total occlusion percutaneous coronary intervention using CT angiography.

The concept of three-dimensional (3D) wiring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is now widely accepted among coronary interventionalists. The 3 axes, i.e., the 2 X-ray beams and the CTO segment, should intersect with each other at as close to a right angle as possible. However, how to specify optimal fluoroscopic angulations for a given CTO segment has not been well established. We aimed to develop a simple and practical method to identify optimal fluoroscopic angulations for CTO PCI. A CTO vector can be derived from slab maximum intensity projection (MIP) images of coronary computed tomography (CT) angiography. Using trigonometric functions, the inner product of vectors and the equation of a plane, we calculated 2 fluoroscopic vectors perpendicular to each other and to the CTO vector. We applied this method to a patient with mid-left circumflex CTO and translated the resulting fluoroscopic vectors into optimal fluoroscopic angulations. To facilitate its use, we developed a calculator using spreadsheet software that can output optimal fluoroscopic angulations within a practical range by inputting the x, y, and z components of the CTO vector. This approach also helps to minimise dead angles in biplane fluoroscopy. This method has the potential to make CTO PCI safer and easier, without requiring dedicated equipment or software. Its effectiveness should be validated in clinical practice.

Visualization of Cerebrospinal Micro-Angioarchitecture

Researchers have been trying to visualize fine angioarchitecture in cerebrospinal vascular lesions and the positional relationship between vascular lesions and surrounding structures. The aim of this article was to introduce the usefulness of imaging in visualizing the microvascular anatomy in cerebrospinal vascular lesions, such as aneurysm, arterial dissection, arteriovenous malformation, dural arteriovenous fistula(AVF), spinal dural and epidural AVF, and craniocervical junction AVF. For the imaging modality, we used high-resolution magnetic resonance imaging, three-dimensional rotational angiography(3D-RA), slab maximum intensity projection image from 3D-RA, cone-beam computed tomography, and fusion imaging. If fully exploited, imaging can contribute to clinical analysis and surgical treatment and be an essential tool for achieving maximum therapeutic effect without complications.

Angioarchitecture of the Normal Lateral Spinal Artery and Craniocervical Junction Arteriovenous Fistula Using Contrast-enhanced Cone-beam CT.

The lateral spinal artery (LSA) perfuses the dorsolateral part of the spinal cord at the craniocervical junction (CCJ). We analyzed the angioarchitecture of the normal LSA and CCJ arteriovenous fistula (AVF). The first study included 26patients with acerebral aneurysm of the posterior circulation. Using slab maximum intensity projection (MIP) images from three-dimensional rotational angiography (3D-RA) and contrast-enhanced cone-beam CT (CE-CBCT), we analyzed the origin of the LSA, its anastomosis with the posterior inferior cerebellar artery (PICA), the point where it reaches the spinal cord, and the visualized range. In the second study, we analyzed the angioarchitecture and treatment results of 7 CCJAVF lesions treated in our department between 2016 and 2021. We visualized the normal LSA for all patients. In 23patients with an intradural origin PICA, all LSAs originated from the C1 or C2 radicular artery, and 8 patients had an anastomosis with the PICA. In three patients with aC1 level origin PICA, all LSAs originated from the PICA. All LSAs reached the dorsolateral part of the spinal cord. The mean visualized range of the LSA was 27.4 mm. The LSA was involved in five of seven CCJAVF lesions (71%). There was one lesion with aspinal infarction after LSA embolization. Other lesions were treated by direct interruption of the AVF, and the ASA and LSA were preserved. This is the first report that visualized the LSA's normal anatomy using slab MIP images from 3D-RA and CE-CBCT. Knowledge of LSA anatomy is critical to avoid complications during the treatment of CCJAVF.

Detection of the common origin of the radiculomedullary artery with the feeder of spinal dural arteriovenous fistula using slab maximum intensity projection image.

Endovascular therapy to the spinal dural arteriovenous fistula (SDAVF) with a common origin of the radiculomedullary artery and the feeder of the shunt has the risk of spinal cord infarction. This study aimed to retrospectively assess the detection rate of normal spinal arteries from the feeder of SDAVF. We retrospectively collected the angiographic and clinical data of SDAVFs. This study included 19 patients with 20 SDAVF lesions admitted to our department between January 2007 and December 2018. We assessed the detection rate of normal radiculomedullary artery branched from the feeder of SDAVF between the period using the image intensifier (II) and flat panel detector (FPD) and evaluated the treatment results. The detection rates of the radiculomedullary artery branched from the feeder of SDAVF were 10% (1/10 lesions) during the II period and 30% (3/10 lesions) during the FPD period. During the FPD period, all normal radiculomedullary arteries branched from the feeder were only detected on slab maximum intensity projection (MIP) images of rotational angiography, and we could not detect them in 2D or 3D digital subtraction angiography. All lesions that had a common origin of a normal radiculomedullary artery and the feeder were completely obliterated without complications. There was no recurrence during the follow-up period. The flat panel detector and slab MIP images seem to show the common origin of the normal radiculomedullary arteries from the feeder more accurately. With detailed analyses, SDAVF can be safety treated.

A simple and software-independent protocol for the measurement of post-cranial bones in anthropological contexts using thin slab maximum intensity projection

Abstract Objective This paper introduces a new protocol for the measurement of post-cranial bones in computed tomography using slab maximum intensity projection. Materials and Methods The steps of the protocol are described and illustrated. Repeatability and accuracy are established through inter and intra observer testing evaluated using TEM, rTEM, and R. Results The protocol performed well in both repeatability and accuracy testing. Conclusion The protocol yields highly repeatable and accurate measurements.

Personalized 3D printed coronary models in coronary stenting

3D printing has shown great promise in cardiovascular disease, with reports mainly focusing on pre-surgical planning and medical education. Research on utilization of 3D printed models in simulating coronary stenting has not been reported. In this study, we presented our experience of placing coronary stents into personalized 3D printed coronary models with the aim of determining stent lumen visibility with images reconstructed with different postprocessing views and algorithms. A total of six coronary stents with diameter ranging from 2.5 to 4.0 mm were placed into 3 patient-specific 3D printed coronary models for simulation of coronary stenting. The 3D printed models were placed in a plastic container and scanned on a 192-slice third generation dual-source CT scanner with images reconstructed with soft (Bv36) and sharp (Bv59) kernel algorithms. Thick and thin slab maximum-intensity projection (MIP) images were also generated from the original CT data for comparison of stent lumen visibility. Stent lumen diameter was measured on 2D axial and MIP images, while stent diameter was measured on 3D volume rendering images. 3D virtual intravascular endoscopy (VIE) images were generated to provide intraluminal views of the coronary wall and stent appearances. All of these stents were successfully placed into the right and left coronary arteries but 2 of them did not obtain wall apposition along the complete length. The stent lumen visibility ranged from 54 to 97%, depending on the stent location in the coronary arteries. The mean stent lumen diameters measured on 2D axial, thin and thick slab MIP images were found to be significantly smaller than the actual size (P<0.01). Thick slab MIP images resulted in measured stent lumen diameters smaller than those from thin slab MIP images, with significant differences noticed in most of the measurements (4 out of 6 stents) (P<0.05), and no significant differences in the remaining 2 stents (P=0.19-0.38). In contrast, 3D volume rendering images allowed for more accurate measurements with measured stent diameters close to the actual dimensions in most of these coronary stents, except for the stent placed at the right coronary artery in one of the models due to insufficient expansion of the stent. Images reconstructed with sharp kernel Bv59 significantly improved stent lumen visibility when compared to the smooth Bv36 kernel (P=0.01). 3D VIE was successfully generated in all of the datasets with clear visualization of intraluminal views of the stents in relation to the coronary wall. This preliminary report shows the feasibility of using 3D printed coronary artery models in coronary stenting for investigation of optimal coronary CT angiography protocols. Future studies should focus on placement of more stents with a range of stent diameters in the quest to reduce the need for invasive angiography for surveillance.

Case 270.

History A 54-year-old woman presented with typical chest pain during physical training at the gym. She had a history of hypertension controlled with hydrochlorothiazide, without any other cardiovascular risk factor and with neither personal nor family history of ischemic heart disease. She was postmenopausal and had a long-standing history of migraine headaches without hormonal or drug therapy. The patient had no history of clinically important thoracic trauma or invasive chest interventions. Initial electrocardiography (ECG) showed signs of ongoing anterior ST segment elevation myocardial infarction, and emergent coronary angiography with angioplasty and intravascular US were performed ( Fig 1 ). Maximal level of high-sensitive T troponins was 820 ng/L (normal, <13 ng/L), while echocardiography showed a normal left ventricular ejection fraction, with no apparent regional wall motion abnormalities. General physical examination findings were unremarkable, excluding ligamentous hyperlaxity and joint instability. C-reactive protein, rheumatoid factor, antinuclear antibody, cytoplasmic antineutrophil cytoplasmic antibody, and angiotensin-converting enzyme blood test results were negative. For further evaluation, arterial phase ECG-synchronized CT angiography from the skull base to the pubis symphysis was performed ( Fig 2 ). Figure 1a: Coronary angiography of the left anterior descending (LAD) and left circumflex (LCX) arteries (30° right anterior oblique and 20° caudally angulated projection) and intravascular US of the LCX artery were performed. (a) Initial coronary angiography projection. (b) Coronary angiography projection after LAD stent placement. (c, d) Intravenous US images of the distal (c) and proximal (d) LCX artery obtained after b. Figure 1b: Coronary angiography of the left anterior descending (LAD) and left circumflex (LCX) arteries (30° right anterior oblique and 20° caudally angulated projection) and intravascular US of the LCX artery were performed. (a) Initial coronary angiography projection. (b) Coronary angiography projection after LAD stent placement. (c, d) Intravenous US images of the distal (c) and proximal (d) LCX artery obtained after b. Figure 1c: Coronary angiography of the left anterior descending (LAD) and left circumflex (LCX) arteries (30° right anterior oblique and 20° caudally angulated projection) and intravascular US of the LCX artery were performed. (a) Initial coronary angiography projection. (b) Coronary angiography projection after LAD stent placement. (c, d) Intravenous US images of the distal (c) and proximal (d) LCX artery obtained after b. Figure 1d: Coronary angiography of the left anterior descending (LAD) and left circumflex (LCX) arteries (30° right anterior oblique and 20° caudally angulated projection) and intravascular US of the LCX artery were performed. (a) Initial coronary angiography projection. (b) Coronary angiography projection after LAD stent placement. (c, d) Intravenous US images of the distal (c) and proximal (d) LCX artery obtained after b. Figure 2a: Arterial phase electrocardiography-synchronized CT angiography from the skull base to the pubis symphysis was performed after coronary angiography, subsequent interventional procedures, and intravenous US. (a, b) Axial oblique slab maximum intensity projection image at the level of the left (a) and right (b) renal arteries. (c) Coronal volume-rendering image shows an anterior view of the renal arteries. Figure 2b: Arterial phase electrocardiography-synchronized CT angiography from the skull base to the pubis symphysis was performed after coronary angiography, subsequent interventional procedures, and intravenous US. (a, b) Axial oblique slab maximum intensity projection image at the level of the left (a) and right (b) renal arteries. (c) Coronal volume-rendering image shows an anterior view of the renal arteries. Figure 2c: Arterial phase electrocardiography-synchronized CT angiography from the skull base to the pubis symphysis was performed after coronary angiography, subsequent interventional procedures, and intravenous US. (a, b) Axial oblique slab maximum intensity projection image at the level of the left (a) and right (b) renal arteries. (c) Coronal volume-rendering image shows an anterior view of the renal arteries.

Assessment of thrombus length in acute ischemic stroke by post-contrast magnetic resonance angiography

ObjectivesPost-contrast magnetic resonance angiography (PC-MRA) enables visualization of vessel segments distal to an intra-arterial thrombus in acute ischemic stroke. We hypothesized that PC-MRA also allows clot length measurement in different...

Application of degree of portal systemic shunting in assessing upper gastrointestinal bleeding in patients with schistosomiasis cirrhosis

To discuss the application of the degree of portal systemic shunting in assessing the upper gastrointestinal bleeding in patients with hepatic schistosomiasis. Thirty-three patients with upper gastrointestinal bleeding caused by hepatic schistosomiasis (a bleeding group) and 29 schistosomiasis cirrhosis patients without bleeding (a non-bleeding group) were enrolled as investigation subjects in Jinshan Hospital. The subjects were scanned by the 128 abdominal slice spiral CT. The portal systemic shunting vessels were reconstructed by using thin slab maximum intensity projection (TSMIP) and multiplanar reconstruction (MPR). The degrees of the shunting vessels of the subjects were evaluated and compared, and the relationship between upper gastrointestinal bleeding and the degree of the shunting was analyzed. In the bleeding group, the occurrence rates of the shunting vessels were found as follows: 86.4% in left gastric varices, 68.2% in short gastric varices, 50.0% in esophageal varices, 50.0% in para-esophageal varices, 37.9% in gastric varices, 69.7% in gastric-renal varices, 51.5% in spleen-renal varices, 25.8% in abdominal wall varices, 15.2% in omentum varices, 63.6% in para-splenic varices, 34.8% in umbilical varices, 40.9% in retroperitoneal-paravertebral varices, and 36.4% in mesenteric varices. In the bleeding group, the occurrence rates and the degree of shunt were significantly higher than those in the non-bleeding group in esophageal varices, esophageal vein, left gastric vein and gastric varices (all P < 0.05). CT portal vein reconstruction can accurately display the location, degree and walking of all kinds of shunting vessels. Esophageal varices, esophageal vein, left gastric vein and gastric varices can accurately predict the risk of upper gastrointestinal bleeding in patients with hepatic schistosomiasis. The patents with higher degree of the shunting vessels have a higher risk of gastrointestinal bleeding.

A ruptured intracranial aneurysm with underlying cervicocranial fibromuscular dysplasia

A 66-year-old woman experienced sudden headache and loss of consciousness for about 10 minutes. After regaining consciousness, she complained of severe pain in her neck and head. On physical examination, she had a stiff neck and bilateral Babinski’s sign. An axial unenhanced computed tomography (CT) scan (Panel A-1) showed extensive subarachnoid hemorrhage, including blood in the basal cisterns and fourth ventricle (arrows). Intraventricular hemorrhage is a classic presentation of the rupture of an anterior communicating artery aneurysm. A maximum intensity projection axial CT angiographic image (Panel A-2) indeed showed an aneurysm of the anterior communicating artery (arrowhead), with a maximum diameter of approximately 4 mm. Interestingly, sagittal (Panel B-1) and coronal (Panel B-2) slab maximum intensity projection CT angiographic images showed that the right extracranial internal carotid artery had a typical ‘string-of-beads’ appearance at the level of the second and third cervical vertebrae (arrows), which is pathognomonic of fibromuscular dysplasia (FMD) of the medial type.1,2 A magnified three-dimensional reconstructed CT angiographic image of the right extracranial internal carotid artery (Panel B-3) confirmed these findings. FMD is a segmental, non-atherosclerotic, noninflammatory disease of unknown cause, and most commonly affects the renal and cervicocranial arteries. It is most often encountered in the fifth decade of life and occurs predominantly in women.1,2 Cervicocranial FMD is often asymptomatic and an incidental finding on imaging or at autopsy.1,2 The condition is also associated with arterial dissection, arteriovenous fistulas, and, importantly, intracranial aneurysms.1,2 Compared to adults without any risk factors in whom intracranial aneurysms are found in Images in vascular medicine

Abstract P2-02-08: 3-Tesla MRI Is More Useful for the Evaluation of Intraductal Spreading Area of Breast Cancer: A Comparative Study with Conventional 1.5-Tesla MRI

Abstract Background: High quality of space and temporal resolution is demanded from the diagnosis for intraductal spreading area of breast cancer. In our hospital, from April 2007, 3-Tesla (T) MRI was transduced and high resolution dynamic studies for bilateral mammary have been performed. We have reported the accuracy of 3-T MRI in the evaluation of intraductal spreading area of breast cancer at 31st SABCS. At this time, we demonstrate our follow-up data. Methods: We assessed 256 patients with primary breast cancer who underwent the 3-T or 1.5-T breast MRI as pre-operative examination between April, 2007 and February, 2010. Concerning the diagnosis of intraductal spreading area of breast cancer, we weighed 3-T MRI against conventional 1.5-T MRI. Using 1.5-T or 3-T MRI (Achieva, Philips), we injected contrast medium (Magnepist) with 0.2ml/kg body weight in 1ml/sec and photographed five aspects before injection and after injection for every 90 seconds. We obtained fat-sat T1-weighted magnetic resonance image (T1WI), multi-planar reconstruction (MPR) image and standard maximum intensity projection (MIP) image based on T1WI by coronal section, and furthermore slab MIP image with Aquerius net (Terarecon), and we evaluated the enhanced area. Results: 138 cases were examed with 1.5-T MRI, and 118 cases with 3-T MRI. In 1.5-T group, 40 cases (30%) were underestimated, additional resection were required intraoperativelly with cancer-cells positive surgical margin in 18 cases (13%), and surgical margin was positive with carcinoma cells by final pathological findings in 12 cases. In two patients we were forced to changes from breast-conserving surgery to mastectomy, and two cases underwent reoperation (mastectomy) with the diagnosis of widely positive surgical margin. In comparison with 1.5-T MRI group, 16 cases (14%) were underestimated in 3-T MRI group, intraoperative addition resection in eight cases (7%), and surgical margin positive by the final pathological findings in 13 cases, respectively. Conclusions: The concern to enhance an artifact is known on 3-T MRI because it has high resolution. However, it may be more useful rather than1.5-T MRI because of its high resolution, to evaluate the intraductal spreading area of breast cancer and to determine the extent of surgical resection. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-02-08.

3-Tesla MRI for the evaluation of spreading area of ductal carcinoma in situ: a comparative study with 1.5-Tesla MRI.

Abstract Abstract #4028 Background: High quality of space and temporal resolution is demanded from the diagnosis for intraductal spreading area of breast cancer. In our hospital, from April 2007, 3-Tesra (T) MRI was transduced and high resolution dynamic studies for bilateral mammary have been performed. However, superiority of 3-T MRI to 1.5-T MRI remains almost unproven in the evaluation of intraductal spreading area of breast cancer.&amp;#x2028; Methods: We assessed 46 patients with primary ductal carcinoma in situ who underwent the 3-T or 1.5-T breast MRI as pre-operative examination between July, 2007 and March, 2008. Concerning the diagnosis of intraductal spreading area of breast cancer, we weighed 3T MRI against conventional 1.5T MRI. Using 1.5-T or 3-T MRI (Achieva, Philips), we injected contrast medium (Magnepist) with 0.2ml/kg body weight in 1ml/sec and photographed five aspects before injection and after injection for every 90 seconds. We obtained fat-sat T1-weighted magnetic resonance image (T1WI), multi-planar reconstruction (MPR) image and standard maximum intensity projection (MIP) image based on T1WI by coronal section, and furthermore slab MIP image with Aquerius net (Terarecon), and we evaluated the enhanced area.&amp;#x2028; Results: 32 cases were examed with 1.5-T MRI, and 14 cases with 3-T MRI. In 1.5-T group, 10 cases (31%) were underestimated, additional resection were required intraoperativelly with cancer-cells positive surgical margin in 7 cases, and surgical margin was positive with carcinoma cells by final pathological findings in 4 cases. In one patient we were forced to changes from breast-conserving surgery to mastectomy, and two cases underwent reoperation (mastectomy) with the diagnosis of widely positive surgical margin.In comparison with 1.5 T MRI group, three (21%) were underestimated in 3-T MRI group, intraoperative addition resection in two cases, and surgical margin positive by the final pathological findings in two cases, respectively.&amp;#x2028; Conclusions: The concern to enhance an artifact is known because 3-T MRI has high resolution, but it may be more useful in the evaluation of intraductal spreading area of breast cancer. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4028.

Postprocessing technique with MDCT data improves the accuracy of the detection of lung nodules

The aim of this study was to determine whether postprocessing techniques could improve the accuracy of detecting lung nodules. A total of 154 segmented lung volumes of multidetector-row computed tomography (MDCT) data were the subject of the study. Lung nodules were present in 88 volumes and absent in 66 volumes. We prepared four groups: (1) 7- or 10-mm thick-section axial images; (2) 1-mm thin-section axial images; (3) sliding slab maximum intensity projection (MIP) images with a slab thickness of 15 mm; and (4) sliding slab volume rendering (VR) images with a slab thickness of 15 mm. Sixteen physicians reviewed each group in interactive cine mode. The observers' performance in the detection of lung nodule was evaluated by receiver operating characteristic (ROC) analysis. The observers' performance of the MIP and VR groups was significantly better than in other two groups. There was no significant difference statistically between the thin and thick groups. The detectability of lung nodules is improved with the use of sliding slab MIP and VR using thin-section image data. Thin-section volume data are essential for improving diagnostic accuracy, but observation of thin-section images without utilization of image-processing techniques dose not improve diagnostic accuracy.

Comparison of Transaxial Source Images and 3-Plane, Thin-Slab Maximal Intensity Projection Images for the Diagnosis of Coronary Artery Stenosis with Using ECG-Gated Cardiac CT

ObjectiveWe wanted to compare the transaxial source images with the optimized three plane, thin-slab maximum intensity projection (MIP) images from electrocardiographic (ECG)-gated cardiac CT for their ability to detect hemodynamically significant stenosis (HSS), and we did this by means of performing a receiver operating characteristic (ROC) analysis.Materials and MethodsTwenty-eight patients with a heart rate less than 66 beats per minute and who were undergoing both retrospective ECG-gated cardiac CT and conventional coronary angiography were included in this study. The contrast-enhanced CT scans were obtained with a collimation of 16×0.75-mm and a rotation time of 420 msec. The transaxial images were reconstructed at the mid-diastolic phase with a 1-mm slice thickness and a 0.5-mm increment. Using the transaxial images, the slab MIP images were created with a 4-mm thickness and a 2-mm increment, and they covered the entire heart in the horizontal long axis (4 chamber view), in the vertical long axis (2 chamber view) and in the short axis. The transaxial images and MIP images were independently evaluated for their ability to detect HSS. Conventional coronary angiograms of the same study group served as the standard of reference. Four radiologists were requested to rank each image with using a five-point scale (1 = definitely negative, 2 = probably negative, 3 = indeterminate, 4 = probably positive, and 5 = definitely positive) for the presence of HSS; the data were then interpreted using ROC analysis.ResultsThere was no statistical difference in the area under the ROC curve between transaxial images and MIP images for the detection of HSS (0.8375 and 0.8708, respectively; p > 0.05). The mean reading time for the transaxial source images and the MIP images was 116 and 126.5 minutes, respectively.ConclusionThe diagnostic performance of the MIP images for detecting HSS of the coronary arteries is acceptable and this technique's ability to detect HSS is comparable to that of the transaxial source images.

Diffuse Telangiectatic Type of Pulmonary Arteriovenous Malformation Diagnosed with CT Scan using Slab Maximum Intensity Projection Technique: A Case Report

Diffuse telangiectatic type of pulmonary arteriovenous malformation (AVM) is an uncommon disease entity in which numerous small arteriovenous connections occur throughout the lungs. It has rarely been confirmed by pulmonary angiography. We report a case of diffuse telangiectatic pulmonary AVM occurring in a patient with dyspnea and confirmed by CT using the slab maximum intensity projection (MIP) technique and conventional direct pulmonary angiography.