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64 Slice MDCT (updated 3/7/08)

Spectrum of aortic valves
Go	Movie #1- aortic stenosis
Go	Movie #2- normal valve
Go	Movie #3- AVR
Go	Movie #4- bicuspid valve

 

Normal coronary CTA
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Normal LAD motion
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Circumflex arises off RCA
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Normal coronary artery analysis
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Normal cardiac chambers 3D mapping demonstrating a flow-enhanced image of blood in chambers of the heart
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Normal aortic root CT angiography demonstrates the ascending aorta on this unremarkable CT visualization of the coronary arteries.
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Reimplantation of coronary artery following aortic root repair 3D and 4D mapping nicely show the focally dilated coronary artery following repair. 3D mapping nicely shows the valve and all motion.
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Dilated ascending aorta 3D and 4D mapping demonstrate dilated ascending aorta.
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Bicuspid aortic valve 3D and 4D mapping demonstrate evidence of bicuspid aortic valve.
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Post-coarctation of aorta repair with stent in place. The stent is patent. 3D and 4D imaging nicely define the stent and repair.
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Pseudoaneurysm of ascending aorta In this patient with aortic valve replacement, there is a collection adjacent to ascending aorta which represents either focal leak or pseudoaneurysm.
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Persistent left superior vena cava emptying into coronary sinus 3D and 4D mapping nicely demonstrate the patient's persistent left superior vena cava emptying into the coronary sinus.
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Evaluation of coronary arteries using sliding MIP technique Multiple 3D reconstructions share the use of sliding MIP to define the coronary arteries
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Aortic valve replacement 4D mapping demonstrates replacement of aortic valve with valve sparing procedure.
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Aortic valve stenosis Extensive calcification and thickening of aortic valve demonstrated on this 4D display.
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3D and 4D mapping demonstrate normally functioning aortic valve replacement (AVR) Evidence of left ventricle hypertrophy can be seen. Note the use of varying rendering techniques for allowing visualization of the aortic valve.
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Dilated aortic root and sinuses of Valsalva 3D and 4D mapping demonstrate the aortic root to be dilated as well as the sinuses of Valsalva. The patient also has a bicuspid valve. This is all nicely seen on 3D and 4D mapping.
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Cor Triatriatum Linear line representing a cleft in the left atrium in a patient with cor triatriatum
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Coronary artery bypass grafts Coronary artery bypass with both saphenous and LIMA grafts
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Dilated aortic root and aortic stenosis 4D mapping demonstrates aortic stenosis with dilated aortic root and sinus of Valsalva.
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Congenital heart disease with stent in pulmonary arteries 4D and 3D mapping demonstrate stents in both main pulmonary arteries with patency of the stents documented by 3D and 4D mapping. Also, good visualization of coronary arteries.
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Reimplanted right coronary artery Following aortic valve surgery, reimplanted coronary artery is seen here with dilatation of implant site. This is nicely seen on 4D imaging.
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Aortic valve replacement 4D mapping demonstrates replacement of aortic valve with valve sparing procedure.
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Aortic valve stenosis Extensive calcification and thickening of aortic valve demonstrated on this 4D display.
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3D and 4D mapping demonstrate normally functioning aortic valve replacement (AVR) Evidence of left ventricle hypertrophy can be seen. Note the use of varying rendering techniques for allowing visualization of the aortic valve.
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Dilated aortic root and sinuses of Valsalva 3D and 4D mapping demonstrate the aortic root to be dilated as well as the sinuses of Valsalva. The patient also has a bicuspid valve. This is all nicely seen on 3D and 4D mapping.
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Cor Triatriatum Linear line representing a cleft in the left atrium in a patient with cor triatriatum
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Coronary artery bypass grafts Coronary artery bypass with both saphenous and LIMA grafts
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Dilated aortic root and aortic stenosis 4D mapping demonstrates aortic stenosis with dilated aortic root and sinus of Valsalva.
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Congenital heart disease with stent in pulmonary arteries 4D and 3D mapping demonstrate stents in both main pulmonary arteries with patency of the stents documented by 3D and 4D mapping. Also, good visualization of coronary arteries.
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Reimplanted right coronary artery Following aortic valve surgery, reimplanted coronary artery is seen here with dilatation of implant site. This is nicely seen on 4D imaging.
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Pseudoaneurysm of ascending aorta In this patient with aortic valve replacement, there is a collection adjacent to ascending aorta which represents either focal leak or pseudoaneurysm.
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Persistent left superior vena cava emptying into coronary sinus 3D and 4D mapping nicely demonstrate the patient's persistent left superior vena cava emptying into the coronary sinus.
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Evaluation of coronary arteries using sliding MIP technique Multiple 3D reconstructions share the use of sliding MIP to define the coronary arteries
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Normal aortic root CT angiography demonstrates the ascending aorta on this unremarkable CT visualization of the coronary arteries.
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Reimplantation of coronary artery following aortic root repair 3D and 4D mapping nicely show the focally dilated coronary artery following repair. 3D mapping nicely shows the valve and all motion.
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Dilated ascending aorta 3D and 4D mapping demonstrate dilated ascending aorta.
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Bicuspid aortic valve 3D and 4D mapping demonstrate evidence of bicuspid aortic valve.
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Spectrum of arotic valves
Go	Movie #1- aortic stenosis
Go	Movie #2- normal valve
Go	Movie #3- AVR
Go	Movie #4- bicuspid valve

 

Normal coronary CTA
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Normal LAD motion
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Circumflex arises off RCA
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Normal coronary artery analysis
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Normal cardiac chambers 3D mapping demonstrating a flow-enhanced image of blood in chambers of the heart
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Coronary artery bypass grafts: 3D mapping nicely shows two saphenous grafts and their relationship to the sternum. 3D mapping nicely defined.
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Repair of coarctation of aorta with stent: 3D and 4D mapping nicely define the stent used to repair a coarctation of the aorta. Good visualization provided on the study.
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Pseudoaneurysm of aortic root: 4D mapping demonstrates a pseudoaneurysm arising off ascending aorta following aortic root repair. The pseudoaneurysm compresses the SVC as well.
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Bicuspid aortic valve:4D imaging nicely defines an excellent example of a bicuspid aortic valve.
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Compression of trachea by right aortic arch with attempted double aortic arch: Sequence of 4D images nicely defines the right aortic arch with the aberrant left subclavian artery forming a ring. The ring is not a complete ring as there is typically a fibrous band, in this case, between the components of the left arch. This is a beautiful example of such a case.
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3D and 4D display demonstrate a case of Marfan's Syndrome with prior repair of the aorta above the valve. Now note the sinuses of Valsalva are dilated due to compressive forces down by the graft which has led to the need for a redo procedure.
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Aortic dissection with compression of the true lumen by false lumen. The true lumen is compromised, particularly the descending thoracic aorta, and some compromise of the abdominal aorta. Note how nicely the true lumen gets compressed during systole. This can result in ischemic changes.
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Patient with prior repair of the descending aorta has a large pseudoaneurysm seen. Note the slow flow in the pseudoaneurysm seen on multiple 3D views. Multiple 3D images and 4D maps were provided to show the pseudoaneurysm and its position as well as relative lack of motion. This is a beautiful case.
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3D mapping of a diseased bicuspid valve with aortic stenosis present. As is typical, the bicuspid valve was calcified.
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Excellent example using MIP (in a fashion best described as a sliding MIP) demonstrates the normal right coronary artery and then using volume rendering to also define the right coronary artery.
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Volume rendering of the pseudoaneurysm arising off the aorta near a zone of prior surgery. The patient, as noted, has a history of congenital heart disease. The pseudoaneurysm is seen in a number of different projections.
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Dilated ascending aorta in a patient with aortic stenosis. Please note that the patient has a normal 3 leaf valve and note that the upper right leaf has some problems with motion in this picture of aortic stenosis.
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Please note on this 4D display a pseudoaneurysm off the right ventricle. This was a complication from prior cardiac surgery
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Multiple 2D and 3D constructions of a perfectly timed cardiac CT angiographic study with normal anatomy. This case consists of a series of 16 different movies using a combination of MIP volume rendering and MPR. 3D and 4D studies also provided.
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4D mapping of a calcified bicuspid valve.
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4D mapping of an aberrant right coronary artery arising off the left cusp.
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3D and 4D mapping showing evidence of two venous bypass grafts [unknown].
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Sequence of images using 4D mapping demonstrates a dissection with compression of the true lumen.
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3D and 4D mapping of a coronary CTA defining the patient's right coronary artery arising from the left cusp.
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4D mapping demonstrates evidence of the diseased aortic valve with aortic valvular stenosis and thickening of the valve leaflets defined in multiple projections. Patient has poor ventricular outflow due to aortic stenosis.
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4D mapping of the patient's prosthetic aortic valve.
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4D mapping of the RCA with dilatation of the anastomosis.
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Evidence of aortic valve replacement surgery with normally functioning aortic valve. Left ventricle is enlarged.
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4D mapping demonstrates evidence of prior repair of a coarctation of the aorta.
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The patient has an aneurysm of the ascending aorta and the arch.
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Dilatation of reimplanted coronary arteries.
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Coronary mapping demonstrates the presence of an aberrant right coronary artery arising off of the left cusp.
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The right coronary artery arises off left cusp: Multiple 3D images nicely define the aberrant origin of the right coronary artery which rises and tracks anteriorly between the pulmonary outflow tract and the aortic root. The left main coronary artery arises in the classic location.
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Normal coronary artery anatomy in 3D: The series of 16 individual videos is used to show normal coronary anatomy, vessel by vessel. This study uses a number of different rendering techniques and is an excellent example of the role of volume rendering, MIP, and curviplanar reconstruction.
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Aortic valve stenosis and enlarged left ventricle: 3D mapping with motion demonstrates the thickened leaves of the aortic valve resulting in aortic stenosis. The patient has an enlarged ventricle and poor ventricular motion consistent with aortic valvular disease and aortic valve stenosis. The patient underwent surgery for aortic valve replacement. This study shows excellent 3D and 4D leads.
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Aortic valve replacement study: Patient status post-AVR and the study nicely shows the normally functioning aortic valve replacement with 4D.
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Bicuspid aortic valve: 4D mapping demonstrates aortic stenosis in a patient with a bicuspid valve.
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Dilatation of origin of reimplanted right coronary artery: The patient is status post-aortic root repair with reimplantation of the right coronary artery. Notice the dilatation of the proximal right coronary artery.
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Diagnoses of aortic valve replacement: 3D and 4D mapping demonstrates aortic valve replacement with normally functioning left ventricle.
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Coarctation tissue of the aorta: 3D mapping and 4D mapping nicely define the thoracic aorta and left subclavian artery in classic location and configuration. Please note presence of collateral vessels off aorta consistent with enlarged intercostals.
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Small left pulmonary trunk: 3D and 4D mapping demonstrate motion at the level of aortic root. This study demonstrates a small left pulmonary trunk.
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Aortic root revision planning: The mapping of this patient was done pre-redo to define the chambers and relationship to sternum as well as coronary arteries. Note the ascending aorta and coronary vessels.
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4D mapping with cardiac window: 4D displays demonstrated through a lateral oblique cut-out view.
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Aberrant right coronary artery: Right coronary artery arises off the left cusp and passes between the aortic root and the main outflow tract. This type of patient commonly has problems and needs reconstructive surgery.
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This study is a nice example of a patient with a prosthetic aortic valve and the valve viewed from multiple rendering positions. The calcifications in the aortic root are seen. Multiple views of the valves leaflets with different renderings also enclosed.
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4D reconstructions of the heart demonstrate a number of findings including how much motion there is in both the right coronary artery, as well as the circumflex on routine cardiac CTA. The study also nicely shows the motion of the mitral valve. Visualization of the individual chambers and their motion during the cardiac cycle was well defined on the study.
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Nice example of visualization of the coronary arteries in a patient with calcifications in the LAD but with no evidence of significant stenosis defined.
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The patient has a right aortic arch and the study demonstrates nicely visualization of the indentation on the trachea and no tracheal stenosis of note is seen. Mirror branching is defined. The patient does have a ductus diverticulum seen, nicely shown.
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The patient has extensive calcifications in the LAD but also extensive non-calcified plaque, and near total occlusion of the vessel as shown nicely on a sequence of renderings.
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Aortic Type B dissection with a markedly narrowed and compressed true lumen by a large false lumen with slow flow. The 3D reconstruction nicely defines the true extent of the dissection and the relationship with the true and false lumen.
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The study uses a range of rendering techniques to nicely visualize the coronary arteries. The color-coding of minimal plaque in the right coronary artery as well as normal origin of left system is nicely defined. The ability to visualize the posterior coronary artery is nicely provided on these images with 4 dimensional display. Please note the entire process is shown with a range of renderings in different cut planes.
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The study demonstrates normal coronary artery origins with a small right coronary artery and right dominant circulation. The trifurcation of the vessel is nicely shown in this example.
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This is a nice example of aortic valve, which is functioning normally.
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This study demonstrates an aberrant location of the right coronary artery off the left cusp nicely shown in the rotated use.
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4D display demonstrates the left ventricle and aortic valve as well as trifurcation vessels off the left main coronary artery with nice visualization provided. No other findings of note seen.
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This study nicely defines the patient's left main coronary artery and bifurcation of LAD and circumflex. The patient's circumflex coronary artery in this case supplies the posterior coronary artery and this represents a left dominant circulation.
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This study demonstrates that the patient's left coronary artery arises off the right cusp and then crosses anteriorly from the ascending aorta. The origin of the coronary arteries is nicely shown on the 3D imaging from the coronal perspective.
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The study demonstrates the function of a prosthetic aortic valve.
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4D Reconstruction: 4D Reconstruction of patient with prior myocardial infarction with abnormal contraction of left ventricle nicely shown on 4D map. Evidence of diseased native coronary arteries with evidence of bypass surgery seen.
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4D Reconstruction: 4D Reconstruction of a St. Jude's aortic valve. Dilated aortic root seen.
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4D Reconstruction: 4D Reconstruction showing a nice example of a pseudo-coarchtation of the aortic arch.
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Coronary CT Anatomy: 3D Display defines aortic root calcifications and calcifications in the left anterior descending coronary artery, as well as calcifications in right coronary and circumflex. The study shows the axial display as well as a 3D volume display. This is the optimal way of looking at the origin of the coronary arteries with the right coronary artery, in this case arising a bit more to the left than usual. The volume display is ideal with the 3D mapping.
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Pericardial Cyst: Four Dimensional display of the left ventricle showing contrast in both left and right ventricles. This study was done without a saline chaser. Notice the right pericardial cyst nicely defined.
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Coronary anatomy: 3D Reconstruction defined nicely the coronary anatomy with definition of the right coronary artery and left circumflex coronary artery in this patient with co-dominant circulation. The renderings through the basic heart are critical in this type of process analysis.
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Cardiac CT: Cardiac CT through a range of perspectives and visualization demonstrating a coronary anomaly with the circumflex coronary artery arising off the right coronary artery.
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Occluded RIMA Graft in a patient with by-pass for aberrant coronary artery: 3D mapping demonstrates the aberrant coronary vessel with the right coronary artery arising off the left cusp. This study was done to define the success of the internal mammary graft. One sees the clips of the graft but the graft is totally occluded in this unfortunate case. Please note that this variation has the pulmonary artery and aorta being squeezing the right coronary artery just past its origin.
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Type A dissection: 4D and 3D Mapping of patient with Type A dissection down to the level of the patient's saphenous by-pass grafts. This study was done for pre-operative planning for a re-do procedure. Remapping is ideal to determine if the location of grafts and any potential dangers or hazards that may result in a re-do cardiac procedure with a second medial sternotomy. 4D images are also nicely shown in this case.
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Right Coronary Artery: arising off left cusp. 3D rendering demonstrating coronary anatomy including coronary venous anatomy at the base of the heart. The right dominant circulation is nicely shown in this example. The patient also has a variant with the right coronary artery arising off the left cusp.
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Coronary Artery: 3D and 4D Reconstructions of aberrant origin of right main coronary artery which arises from the left cusp adjacent to the left main coronary artery.
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Coronary CTA: Coronary CTA demonstrating nicely the right coronary artery and its branches on the base of the heart. This was done off a dual source Definition scanner.
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Coronary arteries: A series of 3D images defining various capabilities of 3D and multiplanar reconstruction for evaluating the coronary arteries through a range of planes and perspectives. The ability and value of 4 dimensional imaging is also nicely illustrated in this example.
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Cardiac CT: Cardiac CT with interactive rendering defining the aortic valve.
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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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Coronary vessels: 3D Mapping using volume rendering showing interactive rendering from the chest wall through the coronary vessels.
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Coronary artery disease: This patient was evaluated for coronary artery disease. Notice the tumor which is felt to be a muscular tumor in the left ventricle arising off the cardiac muscle. Also note the vegetations on the aortic valve. This patient also has a history of intravenous drug abuse.
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Cardiac CT: Cardiac CT with interactive rendering defining the aortic valve.
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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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Coronary arteries: A series of 3D images defining various capabilities of 3D and multiplanar reconstruction for evaluating the coronary arteries through a range of planes and perspectives. The ability and value of 4 dimensional imaging is also nicely illustrated in this example.
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Cardiac CT: Cardiac CT through a range of perspectives and visualization demonstrating a coronary anomaly with the circumflex coronary artery arising off the right coronary artery.
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Coronary vessels: 3D Mapping using volume rendering showing interactive rendering from the chest wall through the coronary vessels.
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Type A Dissection - Axial, Sagittal, and 3D Volume rendered images demonstrate evidence of a Type A dissection. Occlusion of right common iliac artery also seen.
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Coronary Artery Bypass Graft Evaluation - Sequence of 3 Dimensionla and 4 Dimension reconstructions show evidence of a saphenous bypass graft, as well as an aneurysm of the aortic arch.
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Type B Dissection as well as Coronary Artery Disease- 3D and 4D Reconstructions demonstrate multiple vessels and coronary artery disease, as well as a beautiful example of a flap in a descending thoracic aorta seen with different rendering techniques. Please note how using a reverse ramp shows the best definition of the flap.
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Normal Functioning Aortic Valve- 3D and 4D Images demonstrate aortic valve replacement surgery. 4D reconstructions nicely show the normal function of the valve.
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Aortic Valve Replacement- 3D Mapping demonstrates the replaced aortic valve with normal function. Note the dissection in the descending thoracic aorta with prior repair of the ascending thoracic aorta.
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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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Coarctation: A series of 3 dimensional and 4 dimensional views are provided defining a patient with prior repair of a coartation. The 4 dimensional imaging of the heart, with a special focus of the aortic valve shows that it functions normally.
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CT Angiography : CT Angiography demonstrates very poor cardiac output in a patient with a history of prior myocardial infarction, extensive coronary artery disease, and extensive atherosclerotic change. Notice the little change in left ventricular volume, diastole and systole.
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Aortic valve : Sequence of images demonstrates the presence of aortic valve, which appears to function normally, using a reversed ramp for processing..
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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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Normal wall motion: normal cardiac motion is seen on this 4 dimensional image shot from a cranial perspective.
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Atrial myxoma : 3D and 4D reconstruction demonstrate mass in left atrium consistent with atrial myxoma. Note on the 4D imaging, the motion of the lesion
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Focal pseudoaneurysm of the ascending aorta: focal pseudoaneurysm of the ascending aorta is seen on this 3D and 4D display
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Repaired coarctation of the aorta: This is a nice example of a patient who had a coarctation of the aorta, which was subsequently repaired. It was literally impossible to try to figure out the anastomoses when one looked only at the axial images, but in 3D, this is very clear exactly where the anastomoses are. This is just a great example of where multiplanar and 3D imaging becomes so critical.
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Pseudoaneurysm: 3D and 4D imaging of a patient with a pseudo aneurysm of the ascending aorta, just above the coronary arteries.
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Focal pseudo aneurysm of the ascending aorta: Multiple sequences using 3D imaging defining the focal pseudo aneurysm of the ascending aorta. This is also nicely seen on some of the 4D images that are enclosed with this report. Pseudo aneurysms are, indeed, fairly rare but it seems that we are seeing more of them as we do more cardiac CT. This was felt to be post surgical in nature.
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4D Imaging of an enlarged left ventricle with poor cardiac output. Notice the lack of change in the left ventricular volumes as we go from diastole to systole.
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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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3D Mapping with 4D Reconstructions- Showing aproximal calcified plaque in left anterior descending coronary artery, which does not cause any significant stenosis of the vessel. This is volume rendering technique in a grey scale load.
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Primary Sarcoma of Left Atrium - The study is a series of 3D and 4D reconstructions that show a primary cardiac tumor infiltrating the atrium and pulmonary artery. Note the extensive tumor and its spread into the left atrium. The differential diagnosis typically for such cases is between primary mass including a mixoma as well as metastatic disease to the heart. The 3D renderings in part were also used to show the large bulk of the tumor and its compromise on the cardiac structures, suing, again a combination of volume rendering and thin slab MIP.
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3D Mapping with 4D Reconstructions- Showing aproximal calcified plaque in left anterior descending coronary artery, which does not cause any significant stenosis of the vessel. This is volume rendering technique in a grey scale load.
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Primary Sarcoma of Left Atrium - The study is a series of 3D and 4D reconstructions that show a primary cardiac tumor infiltrating the atrium and pulmonary artery. Note the extensive tumor and its spread into the left atrium. The differential diagnosis typically for such cases is between primary mass including a mixoma as well as metastatic disease to the heart. The 3D renderings in part were also used to show the large bulk of the tumor and its compromise on the cardiac structures, suing, again a combination of volume rendering and thin slab MIP.
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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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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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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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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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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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Bicuspid Aortic Valve : 4D of a patient with a bicuspid aortic valve. Please note that the best way to visualize the bicuspid valve in this case is the Fishmouth configuration, when the valve is open.
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3D Rendering showing thoracic motion on a gated CT scan of the heart.
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Cardiac Motion: This is an excellent demonstration of why we need to reconstruct at various sequences in the cardiac cycle. You will note how depending on the contracting heart, the right coronary artery is either absolutely normal or evaluation might be considered limited by motion related artifact. This is why we reconstruct all cases at 10% intervals.
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Normal Cardiac Motion: 3D and 4D Imaging of the Heart including coronary artery evaluation and mitral valve evaluation. Note the mitral valve opening and closing on this sequence of images.
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Coronary Artery Evaluation with MIP/VRT Technique: 3D Mapping of the Coronary arteries with MIP technique as well as with volume rendering technique. This sequence gives a good idea of how different coronary arteries can be evaluate with different rendering techniques.
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Aortic Dissection with Flap: CT Angiography demonstrates dissection of the thoracic aorta extending into the abdominal aorta down into the right iliac vessels. Note the endoluminal visualization.
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The patient has a history of a prior myocardial infarction. You will note on the 4 dimensional studies that the left ventricular appears to have decreased injection fraction. A CT with 4D display is excellent at defining injection fractions.
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Coronary arteries: This study uses sliding MIP through the coronary arteries. This is a nice example of perfect timing and excellent quality reconstruction of the coronary arteries. Don't you wish every case looked that good.
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Mitral valve: Whereas prior studies in this section have defined the aortic valve with the opening and closing of the valve, this study demonstrates the delicate mitral valve opening and closing through a range of perspectives.
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4D Heart: 3D mapping as well as 4D display shows a patient with prior coronary artery bypass surgery , as well as with stents in place.
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4D heart: This study demonstrates in 4D the presence of a mildly dilated ascending aorta and an aortic root. Note the excellent definition of the coronary artery uprising off the aortic root.
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Coronary arteries: This study demonstrates, nicely, in a stacked mode configuration how one can easily follow the coronary arteries when using volume rendering. It is our opinion that multiple perspectives are necessary to correctly diagnosis the presence or absence of coronary artery disease. It is not always a simple diagnosis.
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Aortic valve replacement: This case demonstrates, nicely, the presence of an aortic valve replacement. The 3D mapping clearly shows the normal valve function. The study also demonstrated nicely motion associated with the heart relative to the lung. Even with the 64 slice CT, there is still a potential for motion related artifact, simply due to cardiac pulsation.
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Aortic valve: The study is an excellent example of dense calcification of the aortic valve leaflets leading to aortic stenosis and poststenotic dilatation. Calcifications with this appearance are typically seen in patients with bicuspid aortic valves.
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Coronary artery: 3D mapping showing how one can layout the left coronary vessel to allow visualization. Also the importance at looking at information in every plane is critical in cardiac evaluation.
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4D heart: 3D and 4D rendering of the heart with emphasis on the aortic valve. Another excellent example of the valve opening and closing, shown dynamically by 4D CT.
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4D heart: Sequence of images showing 3D and 4D evaluation of the Aorta and aortic root including aortic valve motion with clear definition of aortic valve opening and closing. Note the value of reversing the look up tables which give a better definition of the cardiac valves. We also enclose in this case, several sequences highlighting the airway and lungs to show the impact of the cardiac motion even on a 64 slice CT on the airways.
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4D heart: 4D rendering of motion of the right coronary artery showing how depending on the percent displayed the right coronary artery is either perfectly viewed or seems to suffer from motion artifact. This is why it is important to view images in multiple phases to obtain the best phase.
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