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Published on: June 3, 2018
Multiplanar reformatting and three-dimensional reconstruction: for pre-operative assessment of the thoracic aorta by
K A Bradshaw1, D Pagano, R S Bonser
1Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK.
Insights
Advanced CT imaging techniques like multiplanar reformats and 3-D reconstruction improve surgical planning for thoracic aorta pathologies. These methods offer better visualization of aneurysms and dissections compared to conventional CT scans.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Surgical Planning
Background:
- Conventional CT is used for thoracic aorta pathology but has limitations.
- Advanced imaging techniques may offer additional benefits for surgical planning.
Purpose of the Study:
- To evaluate the added value of multiplanar reformats, maximum intensity projections, and 3-D reconstruction for surgical planning in thoracic aorta pathology.
Main Methods:
- Retrospective analysis of 53 patients with thoracic aorta pathology.
- Data acquired using spiral CT acquisitions with intravenous contrast.
- Reconstructed images included axial, multiplanar reformats, and 3-D shaded surface displays.
- Radiologists and surgeons reviewed images for additional surgical information.
Main Results:
- 3-D reconstruction and oblique reformats better demonstrated the relationship of aneurysms/dissections to major vessels and saccular aneurysm morphology.
- Oblique reformats were best for coarctation.
- Improved spatial orientation aided surgical planning for type B dissection, fusiform aneurysms, and aortic dilatation.
- Spiral acquisitions allowed for greater anatomical coverage in a single breath-hold.
Conclusions:
- Oblique reformats and 3-D reconstruction provide valuable information for surgical assessment of specific thoracic aorta aneurysms and dissections.
- These advanced techniques aid pre-operative planning beyond standard axial CT images.
Introduction:
Conventional CT demonstrates pathology of the thoracic aorta. This study aimed to evaluate the additional contributions to surgical planning of multiplanar reformatting, maximum intensity projections and three-dimensional (3-D) reconstruction.
Design:
Retrospective. SUBJECT AND METHODOLOGY: Fifty-three patients with newly diagnosed pathology of the thoracic aorta were scanned over a 15-month period; 25 scans were spiral acquisitions. Scans were acquired during and following rapid injection of 100 ml of intravenous iopromide. The reconstructed data was displayed as axial images, oblique or other multiplanar reformats and shaded surface display 3-D reconstructions. Two radiologists and two surgeons reviewed the images. The axial images were assessed initially, subsequently the reformats and 3-D reconstructed views were examined looking particularly for additional information that might add to the surgical management.
Results:
Pathologies encountered were aortic dissection (21 patients, including two with Marfan's syndrome), saccular aneurysms (eight), fusiform aneurysms (16), aortic root and ascending aortic dilatation (seven) and coarctation (one). The relationship of aneurysms and dissections to major vessels are better shown with 3-D reconstruction or oblique reformats. Morphology of saccular aneurysms, particularly the neck, is well shown with 3-D reconstruction. Coarctation was best demonstrated by oblique reformats. There was little additional information from 3-D reconstruction or reformats in assessment of type A dissection. Improved spatial orientation by visualization in varying projections was helpful for surgical planning in certain cases of type B dissection, fusiform aneurysms and aortic root and ascending aortic root dilatation. Spiral acquisitions have the advantage of speed and hence a greater anatomical coverage for a single breath-hold.
Conclusion:
Oblique reformats and 3-D reconstruction, although using identical data as the axial images, in specific cases were felt to aid surgical assessment of aneurysms and dissections, thus assisting pre-operative planning.
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