Imaging Pearls ❯ Cardiac ❯ Cinematic Rendering Cardiothoracic
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- “Black blood cinematic rendering (BBCR) is a newly described preset for cinematic rendering, which creates photorealistic displays from volumetric data sets with the contrast-enhanced blood pool displayed as dark and transparent. That set of features potentially provides for enhanced visualization of endomyocardial and intraluminal pathology, as well as cardiac devices. The similarity of the images to black-blood magnetic resonance imaging (MRI) may allow for expansion of the evaluation of certain types of pathology into patient populations unable to undergo MRI. In the emergency setting, the rapid acquisition time and reasonable post-processing time make this technique clinically feasible. In this expanded experience, we demonstrate an expanded clinical experience with the BBCR technique, highlighting the applications for intraluminal cardiovascular evaluation, especially focused on current and potential emergency radiology applications.”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 - “Black blood cinematic rendering (BBCR) was a recently described color and transparency preset that displays the contrast-enhanced blood pool as both transparent and dark. That creates images similar to black blood cardiac magnetic resonance imaging (MRI). In our experience, BBCR excels in evaluation of cardiovascular intraluminal structures because of improved detail and delineation from the contrast-opacified blood pool. For example, in the emergency setting, intraluminal evaluation of the aorta may help identify a subtle intimal flap and extent of dissection, or characterization and emergent therapy planning of ventricular septal rupture.”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1- “BBCR captures the cardiac valve anatomy and calcifications. CR has been used in the assessment of aortic valve variant anatomy, and BBCR improves the delineation of the valve cusps from the blood pool. Global valve and outflow tract calcification assessment can be challenging to fully capture on 2D imaging, and routine cinematic rendering displays often obscure the calcifications due to the opaque contrast-enhanced blood pool. BBCR has potential for the assessment of calcifications of the valve leaflets, annulus, and outflow tract in planning for transcatheter valve replacements >”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 - “Further, the images produced by BBCR, although derived from standard CT acquisitions, are also fundamentally different. The pixels on a BBCR image incorporate varying color and transparency based on the proportion of different tissue types that contribute to that pixel. As such, there may be information in BBCR images that cannot otherwise specifically be abstracted from standard reconstructions or reformations. How such images and data might feed into graphical processing unit-based artificial intelligence algorithms is not easily predictable but should be explored.”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1 - “With the growing applications of cinematic rendering in cardiovascular imaging, BBCR is valuable for its visualization of intraluminal structures through a dark transparent blood pool. In this expanded experience, we have reviewed our initial experiences with BBCR with cardiac devices, native cardiac valves and coronaries, intracardiac masses, and aortic disease. Given the often-acute presentations of those conditions, many patients may first be evaluated in the emergency setting. Although the creation of any CR images requires a workflow with a standalone workstation and an experienced radiologist, the time to generate BBCR images would be well invested in the relatively rare patient that has an endoluminal cardiac or endovascular conditionthat needed to be optimally evaluated.”
Expanded experience with cardiovascular black blood cinematic rendering
Claire Brookmeyer · Linda C. Chu · Steven P. Rowe · Elliot K. Fishman
Emergency Radiology https://doi.org/10.1007/s10140-024-02209-1
- Results: The BBCR technique was successfully utilized to demonstrate intraluminal cardiac findings in a patient with a normal left ventricle, a patient with a left ventricular mural thrombus, and a patient status-post transcatheter aortic valve replacement.
Conclusions: BBCR is a new method of utilizing volumetric chest CT data in order to provide detailed images of intraluminal anatomy and pathology of the heart. Further study of this promising method is warranted.
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) - “We have empirically developed a preset for the visualization of intraluminal structures within the heart and great vessels. We refer to this preset as black-blood cinematic rendering (BBCR) due to the observation that the visual effect is similar to the appearance of black-blood magnetic resonance imaging. In the following manuscript, we describe the BBCR methodology and provide relevant clinical examples of its application to gated cardiac CT data.”
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) - ”The examples in this manuscript demonstrate the potential utility of the BBCR preset to allow the visualization of normal intraluminal cardiac anatomy as well as important pathologic processes. Although this technique will need to be rigorously compared to other methods of cardiac imaging, there appears to be significant promise in utilizing BBCR for cardiac intraluminal visualization. In particular, the utility of BBCR for identifying changes in myocardial trabeculation (e.g. thinning due to prior infarct or left ventricular non-compaction cardiomyopathy), depicting artificial valves and other devices and diagnosing vegetations, and providing intraluminal views of aneurysms and pseudoaneurysms are all applications that merit exploration.”
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) - “In conclusion, the BBCR method appears to provide high levels of intraluminal anatomic detail for cardiac CT imaging. This may facilitate the detection of important pathologic entities such as intramural thrombus, and may also allow improved evaluation of cardiac devices.”
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) 
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
- Results: The BBCR technique was successfully utilized to demonstrate intraluminal cardiac findings in a patient with a normal left ventricle, a patient with a left ventricular mural thrombus, and a patient status-post transcatheter aortic valve replacement.
Conclusions: BBCR is a new method of utilizing volumetric chest CT data in order to provide detailed images of intraluminal anatomy and pathology of the heart. Further study of this promising method is warranted.
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) - “We have empirically developed a preset for the visualization of intraluminal structures within the heart and great vessels. We refer to this preset as black-blood cinematic rendering (BBCR) due to the observation that the visual effect is similar to the appearance of black-blood magnetic resonance imaging. In the following manuscript, we describe the BBCR methodology and provide relevant clinical examples of its application to gated cardiac CT data.”
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) - ”The examples in this manuscript demonstrate the potential utility of the BBCR preset to allow the visualization of normal intraluminal cardiac anatomy as well as important pathologic processes. Although this technique will need to be rigorously compared to other methods of cardiac imaging, there appears to be significant promise in utilizing BBCR for cardiac intraluminal visualization. In particular, the utility of BBCR for identifying changes in myocardial trabeculation (e.g. thinning due to prior infarct or left ventricular non-compaction cardiomyopathy), depicting artificial valves and other devices and diagnosing vegetations, and providing intraluminal views of aneurysms and pseudoaneurysms are all applications that merit exploration.”
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press) - “In conclusion, the BBCR method appears to provide high levels of intraluminal anatomic detail for cardiac CT imaging. This may facilitate the detection of important pathologic entities such as intramural thrombus, and may also allow improved evaluation of cardiac devices.”
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
Black-blood cinematic rendering: A new method for cardiac CT intraluminal visualization
Steven P. Rowe, Linda C. Chu, Hannah S. Recht, Cheng Ting Lin, Elliot K. Fishman
Journal of Cardiovascular Computed Tomography (in press)
- ”Cinematic rendering is a novel technique which is similar to VR but incorporates a more complex lighting model to create more photorealistic images. It has not been widely studied and is not widely available but it has shown promise in several applications, including cardiac imaging. Rowe et al. published a case of a spindle cell sarcoma of the right ventricle illustrating how cinematic rendering can be used to demarcate the margins and extent of the mass.”
The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
Stephen Liddy et al.
Current Cardiology Reports (2019) 21:103
- ”Cinematic rendering is a novel technique which is similar to VR but incorporates a more complex lighting model to create more photorealistic images. It has not been widely studied and is not widely available but it has shown promise in several applications, including cardiac imaging. Rowe et al. published a case of a spindle cell sarcoma of the right ventricle illustrating how cinematic rendering can be used to demarcate the margins and extent of the mass.”
The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning
Stephen Liddy et al.
Current Cardiology Reports (2019) 21:103
- CR differs from traditional VR in making use of a global lighting model that more realistically takes into account the interactions of propagating photons with the component materials of the imaged volume. As a result, this method enhances surface detail and creates lifelike shadowing effects in order to generate truly photorealistic visualizations from standard CT acquisition volumetric data.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - “ While the advantages of this new technique are still under investigation, potential applications include improved visualization of complex anatomic structures that obviates the need for expensive 3D printing, better display of soft tissue texture that may improve detection and characterization of subtle lesions, improved pre-operative planning, and better trainee and patient engagement.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - In this case series, we have demonstrated the ability of CR visualizations to effectively convey key anatomic information related to coronary artery aneurysms in patients with history of KD. While the role of imaging in following patients with KD has been previously investigated, this is the first reported experience with the novel CR visualization methodology, and these examples demonstrate the potential of this technique for evaluating such complex vascular pathologic states.
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - “As with other 3D visualization methods, CR would be expected to provide a global overview of the disease process that is not easily appreciated on 2D axial or multi-planar reformatted images. In particular, this may help to identify relatively distal, small caliber sites of aneurysmal enlargement, which stand out with high contrast on the 3D images but can be subtle when only 2D images are viewed.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - “Given the anatomic complexity of the mediastinum with many adjacent vascular structures, it may be that CR has intrinsic advantages relative to other 3D methods in being able to accurately display the relative positions of those structures in a manner that may be more intuitively grasped in comparison to less photorealistic depictions. At the same time, the shadowing effects produced by CR can potentially obscure important sites of pathology, so a careful inspection of CR visualizations from multiple viewing angles and with multiple different window settings is necessary.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering
Rowe SP, Zimmerman SL, Johnson PT, Fishman EK
Emergency Radiology (2018) 25:449–453 - Coronary Artery to Pulmonary Artery Fistulae Involving both the LAD and RCA
- cinematic rendering makes use of a more complex lighting model that creates photorealistic images with improved detail and that demonstrate shadowing effects that allow for robust visualization of the relative positions of structures - “Cinematic rendering (CR) a new method of 3D computed tomography (CT) volumetric visualization that produces photorealistic images. As with traditional 3D visualization methods, CR may prove to be of value in providing important information when evaluating regions of complex anatomy such as the heart.”
Cinematic rendering of cardiac CT volumetric data: Principles and initial observations
Rowe SP, Johnson PT, Fishman EK
J Cardiovasc Comput Tomogr. 2018 Jan - Feb;12(1):56-59. - “Appropriate selection of window presets using either a ramp (for tissues differing markedly in attenuation such as bone in comparison to adjacent soft tissue) or trapezoid method (for differentiation of similar attenuation structures such as adjacent soft tissues) and slab thickness will allow for appropriate display of pathology and will ensure that a finding of interest is not obscured by an overlying structure.”
Cinematic rendering of cardiac CT volumetric data: Principles and initial observations
Rowe SP, Johnson PT, Fishman EK
J Cardiovasc Comput Tomogr. 2018 Jan - Feb;12(1):56-59. - “While the shadowing effects that arise from the global lighting model that is used contribute to the photorealistic quality of the images, shadowing can also potentially obscure important pathology.”
Cinematic rendering of cardiac CT volumetric data: Principles and initial observations
Rowe SP, Johnson PT, Fishman EK
J Cardiovasc Comput Tomogr. 2018 Jan - Feb;12(1):56-59.
- “Additional considerations that refine CR photorealism include the incorporation of shadowing effects that derive from assuming that the light source can be obscured by objects within the visualized volume. Such shadowing is not typically included in traditional VR, although it is possible to incorporate.8 Furthermore, while CR can use one or more unidirectional light sources as is done in VR, more typically an en- vironment map is used (i.e. texture maps that are related to the brightnesses of surfaces within a virtual scene and more accurately reflect realistic lighting scenarios).”
Cinematic rendering of cardiac CT volumetric data: Principles and initial observations Steven P. Rowe, Pamela T. Johnson, Elliot K. Fishman Journal of Cardiovascular Computed Tomography 12 (2018) 56–59 - “Kawasaki’s disease (KD) is a vasculitis that predominantly affects children and can lead to the development of coronary artery aneurysms. These aneurysms can subsequently thrombose and occlude, which may lead to chest pain and other signs and symptoms of acute coronary syndrome in young patients. Coronary CT angiography, including 3D visualization techniques, is a common modality used in the follow-up of KD patients. In this series of three patients, we present the typical coronary artery imaging findings that can appear in these patients, with an emphasis on the use of the novel 3D technique of cinematic rendering (CR). CR utilizes a different lighting model than other 3D methods and is able to produce highly-detailed, photorealistic images. The potential advantages of CR images in understanding the complex mediastinal vascular anatomy and the relationships of coronary artery aneurysms to other anatomic structures are emphasized.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering Steven P. Rowe1 & Stefan L. Zimmerman1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (in press) - “The most important potential complication of KD is in- flammatory damage to the coronary arteries, which classically leads to the formation of coronary artery aneurysms. These aneurysms will often undergo vascular remodeling and partial
thrombosis in order to produce a psuedonormal vascular lu- men. However, progressive thrombosis and other stenotic pro- cesses such as fibrosis can, over time, precipitate cardiac is- chemia that can lead to emergency room presentations for chest pain or other signs of acute coronary syndrome and necessitate invasive and/or surgical interventions. Of note, computed tomography (CT) angiography, including 3D methods such as volume rendering (VR), has been found to provide suitable non-invasive evaluation of the coronary arteries in patients with KD.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering Steven P. Rowe1 & Stefan L. Zimmerman1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (in press) - “As with other 3D visualization methods, CR would be expected to provide a global overview of the disease process that is not easily appreciated on 2D axial or multi-planar reformatted images. In particular, this may help to identify relatively distal, small caliber sites of aneurysmal enlargement, which stand out with high contrast on the 3D images but can be subtle when only 2D images are viewed. Given the anatomic complexity of the mediastinum with many adjacent vascular structures, it may be that CR has intrinsic advantages relative to other 3D methods in being able to accurately display the relative positions of those structures in a manner that may be more intuitively grasped in comparison to less photorealistic depictions.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering Steven P. Rowe1 & Stefan L. Zimmerman1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (in press) - “Even if CR demonstrates no, or only marginal, advantages relative to VR in terms of clinical applicability, the photorealistic appeal of these images will almost certainly lead to wide- spread use in trainee and patient education.”
Evaluation of Kawasaki’s disease-associated coronary artery aneurysms with 3D CT cinematic rendering Steven P. Rowe1 & Stefan L. Zimmerman1 & Pamela T. Johnson1 & Elliot K. Fishman Emergency Radiology (in press)