CT evaluation of musculoskeletal trauma: initial experience with cinematic rendering

Multi-detector computed tomography (MDCT) scanners that can quickly acquire volumetric datasets composed of isotropic voxels laid the groundwork for the widespread clinical implementation of 3D MDCT reconstructions, with maximum intensity projection (MIP) and volumetric rendering (VR) becoming important parts of the imaging evaluation of patients with a wide variety of pathologic conditions. Recently, a new 3D reconstruction technique known as cinematic rendering (CR) has become available and is now U.S. FDA approved. CR bears fundamental similarities to VR, but utilizes a more complex lighting model to bring about photorealistic reconstructions. While a tremendous amount of work remains to be done in order to understand the advantages and disadvantages of CR in comparison to traditional 3D reconstruction methods, the images themselves are strikingly detailed and can be interactively manipulated to highlight a variety of different tissue types and anatomic structures. In the following pictorial essay, we provide a number of clinical examples of the use of CR in musculoskeletal imaging, including the evaluation of complex fractures, the delineation of the relationship of fractures to adjacent vasculature and overlying soft tissues, and the visualization of vascular and soft tissue injuries.