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Standardized Evaluation of CT Angiography with Remote Generation of 3D Video Sequences for the Detection of Intracranial Aneurysms

¹ From the Departments of Neuroradiology (B.F.T., N.C.K., M.S., W.J.H.) and Neurosurgery (P.H., C.S., J.R.), University of Erlangen-Nuremberg, Germany; and the Visualization and Interactive Systems Group, University of Stuttgart, Germany (S.I-B., T.E.). Presented as a scientific exhibit at the 2001 RSNA scientific assembly. Received September 18, 2002, revision requested October 22, revision received and accepted October 23. Address correspondence to B.F.T. (e-mail: tomandl@neuroradiologie-erlangen.de).

View larger version (132K): [in a new window]   Figure 1a.  Comparison of section images from CT angiography to 3D representation in a patient with severe subarachnoid hemorrhage and aneurysms of both internal carotid artery (ICA) bifurcations. The left aneurysm is calcified. (a) Axial section image at the level of the circle of Willis shows an aneurysm at the bifurcation of the right ICA (arrow). The basal cisterns are filled with subarachnoid blood (arrowheads). For a better comparison with the 3D image,the view is from above. (b) Axial section image at the level of a calcified aneurysm of the left ICA bifurcation (arrow). The extent of the intramural calcification is clearly demonstrated (arrowheads). Again, the view is from above. (c) Superoinferior 3D visualization with direct volume rendering shows the two aneurysms (arrows) in relation to the intracranial arteries and the skull base. The intramural calcification within the left aneurysm is demonstrated, but its extent is not clearly seen (arrowhead). Note that brain tissue and subarachnoid blood are not demonstrated within the 3D representation because the selected thresholds do not include the voxels containing this information.

View larger version (127K): [in a new window]   Figure 1b.  Comparison of section images from CT angiography to 3D representation in a patient with severe subarachnoid hemorrhage and aneurysms of both internal carotid artery (ICA) bifurcations. The left aneurysm is calcified. (a) Axial section image at the level of the circle of Willis shows an aneurysm at the bifurcation of the right ICA (arrow). The basal cisterns are filled with subarachnoid blood (arrowheads). For a better comparison with the 3D image,the view is from above. (b) Axial section image at the level of a calcified aneurysm of the left ICA bifurcation (arrow). The extent of the intramural calcification is clearly demonstrated (arrowheads). Again, the view is from above. (c) Superoinferior 3D visualization with direct volume rendering shows the two aneurysms (arrows) in relation to the intracranial arteries and the skull base. The intramural calcification within the left aneurysm is demonstrated, but its extent is not clearly seen (arrowhead). Note that brain tissue and subarachnoid blood are not demonstrated within the 3D representation because the selected thresholds do not include the voxels containing this information.

View larger version (145K): [in a new window]   Figure 1c.  Comparison of section images from CT angiography to 3D representation in a patient with severe subarachnoid hemorrhage and aneurysms of both internal carotid artery (ICA) bifurcations. The left aneurysm is calcified. (a) Axial section image at the level of the circle of Willis shows an aneurysm at the bifurcation of the right ICA (arrow). The basal cisterns are filled with subarachnoid blood (arrowheads). For a better comparison with the 3D image,the view is from above. (b) Axial section image at the level of a calcified aneurysm of the left ICA bifurcation (arrow). The extent of the intramural calcification is clearly demonstrated (arrowheads). Again, the view is from above. (c) Superoinferior 3D visualization with direct volume rendering shows the two aneurysms (arrows) in relation to the intracranial arteries and the skull base. The intramural calcification within the left aneurysm is demonstrated, but its extent is not clearly seen (arrowhead). Note that brain tissue and subarachnoid blood are not demonstrated within the 3D representation because the selected thresholds do not include the voxels containing this information.

View larger version (52K): [in a new window]   Figure 2.  Traditional workflow of CT angiography (CTA). The data are analyzed by an individual user on a commercially available workstation.

View larger version (28K): [in a new window]   Figure 3.  Workflow of CT angiography (CTA) using a Web service. The 3D visualization is user independent.

View larger version (158K): [in a new window]   Figure 4a.  (a) 3D visualization of intracranial arteries from a posterosuperior view parallel to the clivus. The basilar artery (small arrow) is not visible because of overlying venous structures (large thin arrow). An aneurysm is seen within the left MCA bifurcation (large thick arrow). (b) Venous structures are eliminated by a clipping plane (yellow dotted line) parallel to the clivus. Left posterolateral view. (c) Application of the clipping plane allows an open view of the basilar artery (arrow) in the posterosuperior direction.

View larger version (110K): [in a new window]   Figure 4b.  (a) 3D visualization of intracranial arteries from a posterosuperior view parallel to the clivus. The basilar artery (small arrow) is not visible because of overlying venous structures (large thin arrow). An aneurysm is seen within the left MCA bifurcation (large thick arrow). (b) Venous structures are eliminated by a clipping plane (yellow dotted line) parallel to the clivus. Left posterolateral view. (c) Application of the clipping plane allows an open view of the basilar artery (arrow) in the posterosuperior direction.

View larger version (143K): [in a new window]   Figure 4c.  (a) 3D visualization of intracranial arteries from a posterosuperior view parallel to the clivus. The basilar artery (small arrow) is not visible because of overlying venous structures (large thin arrow). An aneurysm is seen within the left MCA bifurcation (large thick arrow). (b) Venous structures are eliminated by a clipping plane (yellow dotted line) parallel to the clivus. Left posterolateral view. (c) Application of the clipping plane allows an open view of the basilar artery (arrow) in the posterosuperior direction.