Videos : Vascular


CT angiography of the forearm with vascular mapping
Sequence of images using axial, coronal and sagittal planes as well as various volume rendered images to define muscle, vascular and bony maps of the elbow
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CT angiography of the lower extremity: showing the capabilities of interactive rendering looking at bone, muscle, and vasculature in real time.
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Venous-to-venous varix: Volume rendering MIP and Multiplanar reconstructions demonstrates a very unusual case. Notice the vascular abnormality in the region of the right hilum. This was a venous-to-venous varix.
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LIMA and saphenous graft: Volume rendering defining the presence of both a LIMA and saphenous graft and showing the detail that CT can provide for accurately defining the grafts.
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Hemangioma of the Shoulder: 3D Mapping demonstrates a vascular mass in the supercavicular zone on the left in this child consistent with a large cavernous hemangioma.
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Runoff study: 3D reconstructions demonstrate vascular map from the lower aorta to lower extremities showing vascular mapping with extensive disease in the superficial femoral arteries, popliteal and trifurcation vessels.
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AV malformation: The patient has evidence of a hypervascular lesion in the dome of the liver with perfusion changes associated with it. This was an AV malformation nicely defined, particularly in the 3D map.
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Liver AV Malformation: A combination of axial, multi-planar and 3D reconstructions demonstrates evidence of an AV malformation in the left lobe of the liver.
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Bicuspid valve: 4 dimensional and 3 dimensional visualization of the aortic valve prior to operative repair. This is a bicuspid valve.
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Arch pseudoaneurysm: The patient has evidence of a pseudoaneurysm off the arch, which is felt to be a post-surgical complication.
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Coronary artery angiogram: 3D reconstruction and 4 D reconstructions of a coronary artery angiogram that was normal. The role of visualization and looking at multiple planes and perspectives is nicely defined in this case.
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Persistent Left SVC: 3D mapping demonstrates the presence of a persistent left SVC in this patient with dilated aortic root.
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Post CABG: 3D and 4D mapping of a patient post-cardiac bypass demonstrating the grafts as well as cardiac motion.
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LIMA graft: 3D mapping demonstrating a patient's LIMA graft, which is patent. Volume rendering and MIP are very good for looking at graft patency on an interactive display.
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Left venticle aneurysm: 3D mapping demonstrates an aneurysm of the tip of the left ventricle with thinning of the myocardium and asymmetric contraction.
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Normal coronery MIP: A nice example of maximum intensity projection to visualize the coronary arteries. The coronary arteries in this case were normal.
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Calcified aortic valve: 3D and 4D mapping demonstrates a tricuspid aortic valve with calcifications on the valve.
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Dilated aortic root: A sequence of images defines the dilated aortic root with good definition of both the root and valve. The use of 3D and 4 D imaging is nicely shown in this case. Note calcification in the patient's left anterior descending coronary artery.
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LAD stenosis: 3D and 4D mapping demonstrates extensive calcification in areas of stenosis in both the left anterior descending and circumflex coronary artery.
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Diseased bicuspid valve: Sequence of images shows a bicuspid aortic valve with thickening of the valve present, nicely seen on the 4 dimensional map.
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Arch Pseudoaneurysm : A sequence of images is provided using both 3D and 4 D reconstruction in a complicated case of a patient with a pseudo-aneurysm off the aortic arch. 3D mapping defines the extent of aneurysm using a series of axial, coronal, and sagittal planes with volume rendering and 3D mapping. The 4 dimensional reconstructions also nicely show the ulceration with aneurysm off the arch. This can be best described as a pseudo-aneurysm. The multiple volume rendered views nicely show the pseudo-aneurysm.
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Loetz-Dietz Syndrome: The patient has a history of Loetz-Dietz Syndrome. The study is done to look for aneurysm. No aneurysm is found and this study demonstrates great detail in the vessels of the neck, as well as optimal visualization of the mandible and the skull with extensive changes of the rendering algorithms to visualize bone, muscle, and vessels.
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Poor cardiac function: Image displayed in coronal MPR, as well as 3D rendering, demonstrates poor cardiac function with little change in the volume of the left ventricle, between systole and diastole. This is nicely shown on multiple sequences.
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Prior cardiac surgery: The patent has a history of prior cardiac surgery. Notice the bulge off the right side of the ascending aorta consistent with a pseudo-aneurysm, possibly iatrogenic in nature. This is clearly seen on all 3D reconstructions as a discreet out-patching. This would be eventually repaired by banding.
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Ascending Aortic Aneurysm - This is an example of an aneurysm of the ascending thoracic aorta evaluated with both 3D and 4D reconstructions. This study, which is done through a range of perspectives, also shows extensive coronary artery disease with calcification and mild stenosis in multiple vessels. Calcification in the aortic arch also well defined, particularly on the MIP image set.
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AV Shunt Dialysis Patient- On this case is a nice example of the role of 3D in the visualization of large volumes of complex vascular anatomy. This study shows a vascular anatomy of a patient with an AV shunt for dialysis. You will note how hard it is to follow specific vessels in anastomoses on this scrolling axial images while on 3D mapping the anastomoses are much better defined and the vascular map so much easier to understand.
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Type A Dissection of the Aorta following Valve Replacement and Composite Graft- The patient has had a redisecction above the level of the aortic valve replacement and proxal route placement. This dissection shown on 3D imaging best defines the true nature of the dissection as well as the extent down to the level of the patient's graft in the ascending aorta. No other findings of note were seen. 3D mapping enclosed with this report. Please note that we also presented the information using 4D display, which seems to be especially helpful in this clinical problem.
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Ascending Aortic Aneurysm - This is an example of an aneurysm of the ascending thoracic aorta evaluated with both 3D and 4D reconstructions. This study, which is done through a range of perspectives, also shows extensive coronary artery disease with calcification and mild stenosis in multiple vessels. Calcification in the aortic arch also well defined, particularly on the MIP image set.
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AV Shunt Dialysis Patient- On this case is a nice example of the role of 3D in the visualization of large volumes of complex vascular anatomy. This study shows a vascular anatomy of a patient with an AV shunt for dialysis. You will note how hard it is to follow specific vessels in anastomoses on this scrolling axial images while on 3D mapping the anastomoses are much better defined and the vascular map so much easier to understand.
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SMA Syndrome : This is a classic example of SMA Syndrome with marked decrease in the angle between the SMA and the aorta as well as compression of the renal vein. The compression of the renal vein results in many of the collaterals seen in the region of the left renal hilum.
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Right Arch with Mirror Branching : This is an example of an unusual variation of a right-sided arch with a near double aortic arch but lack of connection of the left portion and right portion of the arch. There is mirror branching present as well. This configuration can lead to airway compression but not with the frequency that one would see with a true double aortic arch. The patient does have a diverticulum off the left component of the arch.
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Left Neck AVM: This is a demonstration of a large vascular mass in the left superclavicular region with large feeding and draining vessels consistent with an AV malformation.
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Diseased LAD: 3D and 4D mapping of the coronary CT angiogram demonstrating evidence of plaque and stenosis in the patient's left anterior descending coronary artery.
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Loeyes Dietz Syndrome: A newly described syndrome called Loeyes Dietz has been described and consists of multiple vascular aneurysms as well as tortual vessels and this is one patient with this syndrome.
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Ascending aorta : This is a study done with 3D and 4D mapping demonstrating a dilated ascending aorta down to the level of the aortic root. This study also shows you the amount of motion present on the CT scan and the advantages of gating. Note the pulmonary vasculature motion as well as the significant motion of the ascending aorta. This patient had aortic stenosis as the cause of the dilated aorta.
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SMA Syndrome: Vascular mapping demonstrates information in a range of perspectives from sagital to coronal to 3D volume rendering. This study does show the dilated stomach and small bowel with a rapid transition at the level of the SMA.
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Stents: Coronary artery disease with coronary artery stents in place seen on the volume rendered images. The patient also has a prosthetic valve which functions normally.
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RCA Motion: 4D rendering is done to show the extent of the motion that the right coronary artery normally goes through in a routine scan due to the patient's heartbeat. You will note that the key then would be to select a time when the coronary artery is most relaxed and is best to visualize. This is why 30% often works and why you have to be selective.
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Popliteal Aneurysms: Multiple different rendering techniques as well as multiplanar reconstruction can be used in this patient with bilateral popliteal artery aneurysm arch on the left and the right side. 3D Mapping especially shows this well.
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Lower Extremity Run Off Study: CT Angiography demonstrates extensive disease in both superficial femoral arteries as well as in trifurcation vessels, nicely shown in 3D mapping.
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3D Volume Rendering of a Diabetic Foot with Ulceration : Routine use of volume rendering shows soft tissue abnormalities, as well as amputation of the fifth digit.
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CTA arm: Hall of fame case showing occluded shunt in forearm with detailed vascular mapping.
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SMA: Occlusion of SMA and resultant ischemic bowel. Note amazing detail in this SICU patient.
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Leg: Detailed vascular mapping in a 15 second acquisition.
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Leg: 3-D mapping demonstrates vascular mass of the left leg in a patient who had prior trauma to the tibia and fibula. Patent vascular map present.
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Liver AVM: 3-D mapping demonstrates a vascular lesion in the dome of the liver with the perfusion changes next to it. On the 3D map, the lesion has a cluster appearance consistent with an AV malformation.
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LAG CT Stent: 3-D mapping shows a stent in the junction of the superficial femoral artery and popliteal artery. The stent is patent and well defined on this exam. This was done with .75 mm thick sections.
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CTA leg: This is a CT angiogram of the leg. Multiple renderings were obtained including a high opacity to define skin, an increased transparency to define muscle, and specific CT angiographic displays as well as targeting the trifurcation vessels.
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Klippel-Trenaunay-Weber syndrome : This patient has Klippel-Trenaunay-Weber syndrome and the study demonstrates the venous malformations in the right leg.
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Leg CTA stent: CT angiogram of the lower extremity defines a stent in the distal SFA. which is patent.
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CT angiography defines evidence of a stenosis in the SFA on the right as well as in the peritoneal.
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Cardiac: Multiple 3D images demonstrated poor contractility in a pre-op left ventricular reconstructive surgery.
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Cardiac: 3D mapping demonstrates extensive coronary artery disease with bypass grafts in place. Soft plaque in right coronary artery is seen. Poor left ventricular function is noted.
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Carotid: 3D mapping of the carotid arteries using a 64 slice scanner. Note the detail of vessels and thyroid gland.
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Angio of the foot: Real time rendering defines the detail possible with peripheral CT angiography. color mapping (#2,#3) is ideal for this application
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Superior Mesenteric Vein Clot: Interactive rendering with MIP demonstrates clot in the SMV extensive collateralization seen around stomach. The etiology of the SMV clot was not clear from the study. No pancreatic mass was seen. Patient did have a history of pancreatitis which may have contributed to the process.
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Interactive rendering with MIP

Pulmonary Embolism: 3D mapping demonstrates infiltration of hilar regions by tumor but no evidence of pulmonary embolism was seen.
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3D