PMC10027509_01
Patient 1: A 4-year-old male with aortic coarctation. (a) Sagittal contrast-enhanced 2D CT and (b) VR images demonstrate the coarctation (red arrow) distal to the left subclavian artery. (c) Sagittal contrast-enhanced CR image demonstrates improved 3D visualization of the coarctation (red arrow), as well as highlights the prominent left subclavian artery. The persistent left-sided SVC seen on the VR image could also be subtracted using the CR technique, emphasizing the entire course of the aortic arch without obscuration.
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The 2D contrast-enhanced sagittal image in Fig. 1a shows the coarctation in the classic location just distal to the left subclavian artery with focal, severe narrowing. Fig. 1b) was excluded in this image by utilizing cut planes. Fig. 2 demonstrates two coronal CR images from the same patient. Fig. 2a highlights the entire course of both the right and left internal mammary arteries, dilated due to collateral circulation, and their relationship to surrounding structures.
Patient 1: (a) Coronal CR post-contrast image of the same patient with aortic coarctation highlights the prominent internal mammary arteries (red arrowheads), as well as their relationship to the surrounding structures. (b) Coronal CR post-contrast image set deeper within the thorax provides additional 3D global assessment, demonstrating the entire course of the ascending thoracic aorta (red arrowhead), as well as the persistent left-sided SVC (red arrow).
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Fig. 1b) was excluded in this image by utilizing cut planes. Fig. 2 demonstrates two coronal CR images from the same patient. Fig. 2a highlights the entire course of both the right and left internal mammary arteries, dilated due to collateral circulation, and their relationship to surrounding structures. The coronal CR image in Fig. 2b provides a global assessment of the aorta as well as adjacent structures and shows the persistent left-sided superior vena cava.
PMC10027509_02
Patient 2: An 8-year-old male with a pulmonary sling. (a) Axial contrast-enhanced 2D image demonstrates the pulmonary sling, with the left pulmonary artery (red arrowhead) arising from the right pulmonary artery, coursing posterior to the trachea (red arrow) and anterior to the descending thoracic aorta (white arrowhead). (b, c) Axial and axial oblique contrast-enhanced CR images provide improved 3D visualization of the course of the left pulmonary artery (red arrowhead), and its relative position to the expected location of the adjacent airway and descending thoracic aorta (red arrowhead). (d) Coronal oblique contrast-enhanced CR image provides a unique view of the pulmonary sling, highlighting the sharp turn of the left pulmonary artery (red arrowhead), which is not as well appreciated in the standard 2D images.
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The 2D axial image in Fig. 3a demonstrates the classic appearance of a pulmonary sling, with the aberrant left main pulmonary artery arising from the distal right main pulmonary artery, coursing between the trachea and the esophagus and anterior to the descending thoracic aorta. The axial and axial oblique CR images (Fig. 3b and c) provide full 3D visualization of the pulmonary sling and distal intraparenchymal vessels, a more complete assessment of the surrounding organs, and further information about the location of the sling relative to the other intrathoracic structures. The oblique coronal CR image in Fig. 3d provides a unique view of the course of the left pulmonary artery, in a tight, anatomically complex region, which could not be visualized on standard MDCT imaging.
PMC10027509_03
Patient 3: An 8-week-old male with a history of a left-sided aortic arch and aberrant right subclavian artery. (a) Fluoroscopic image from a modified barium swallow examination demonstrates an impression on the posterior esophagus in its mid to upper portion (red arrow). (b) Axial contrast-enhanced CT demonstrates the left-sided arch (red arrow), with the aberrant right subclavian artery (red arrowhead) coursing posterior to the trachea and enteric tube. (c) Oblique coronal contrast-enhanced CR image provides markedly improved 3D visualization of the surrounding structures, particularly the trachea (red arrowhead) and lung (red arrow). CR can reveal the textural differences between the distinct tissues and provides a global evaluation not attainable via the standard 2D CT images as shown by the movie depicting the aberrant right subclavian artery. (d) Coronal, posterior approach contrast-enhanced CR image provides an additional view of the course of the aberrant artery (red arrowhead), and its relationship to the surrounding structures.
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A prior modified barium swallow demonstrated aspiration and a posterior indentation on the thoracic esophagus, as seen in Fig. 4a. The 2D axial image in soft tissue windows in Fig. 4b reveals a normal left-sided arch with an aberrant right subclavian artery with a retroesophageal course, the etiology of the posterior indentation seen on fluoroscopy. The oblique CR image in Fig. 4c provides a more global visualization of the aberrant subclavian artery (see Fig. 4c movie). The coronal CR image (Fig. 4d) presents a unique view of the origin and course of the aberrant subclavian artery from a posterior approach, providing further 3D information.
PMC10027509_04
Patient 4: A 22-month-old female with a double aortic arch. (a, b) Coronal contrast-enhanced maximum intensity projection (MIP) images demonstrate the double aortic arch, with the slightly larger and higher right arch (red arrowhead) compared to the left (red arrow). (c) Coronal contrast-enhanced CR image at the same level provides improved photorealistic detail, and with better visualization of the relationship of the right arch (red arrowhead) and left arch (red arrow) to the surrounding structures (see movie).
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Coronal VR images seen in Fig. 5a and b demonstrate a double aortic arch, with a larger and more superiorly located right arch. The same view of the double arch is seen in the CR image in Fig. 5c; however, the CR provides improved visualization of the location of the double aortic arch within the thorax, as well as increased photorealism.
Patient 4: (a, b) Axial and coronal oblique contrast-enhanced CR images from the same patient give a clear view of the complete ring (red arrowheads) that is formed by the double arch. The coronal oblique contrast-enhanced CR image (b) clearly delineates the encircling of the trachea (red arrow) by the vascular ring (red arrowheads). (c) The coronal contrast-enhanced CR image provides improved textural differences between the airways, lungs, and cardiovascular structures. The anterior aspect of the vascular ring was subtracted, providing a clear view of the entire course of the trachea (red arrowhead) and proximal mainstem bronchi. See movie illustration of enhanced views provided by CR.
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The axial and axial oblique CR images seen in Fig. 6a and b, respectively, demonstrate an excellent view of the complete vascular ring, providing a unique 3D view of the trachea encircled and confined by the double aortic arch (see movie depicting the CR view of the double arch of patient 4 associated with Fig. 5, Fig. 6).
PMC10027509_05
Patient 5: A 3-month-old male with a hybrid pulmonary lesion. (a, b) Axial contrast-enhanced 2D CT images at the level of the hybrid lesion. The 2D image in lung windows (a) highlights the cystic nature (red arrowhead) of the hybrid lesion. The 2D image in soft tissue window (b) demonstrates the abnormal vascular supply (red arrowhead); however, there is limited evaluation of the adjacent lung parenchyma. (c) The axial CR image demonstrates the contrasting textures between the liver (red arrow), heart (white arrowhead), and vasculature (red arrowhead). The CR image also provides an excellent 3D perspective of the lesion and relationship to adjacent structures, which could be advantageous in surgical planning.
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The axial 2D image in lung window (Fig. 7a) demonstrates the cystic component of the lesion, while the axial 2D image in soft tissue window (Fig. 7b) reveals the vascular component. The axial CR image (Fig. 7c) provides improved photorealistic detail of the lesion as well as textural information.
Patient 5: (a, b) Sagittal and coronal contrast-enhanced MIP images from the same patient show the infradiaphragmatic feeding artery (red arrowhead) arising from the celiac trunk (red arrow) off the abdominal aorta. (c, d) Sagittal and coronal contrast-enhanced CR images provide improved 3D visualization of the feeding artery (red arrowhead), celiac trunk (red arrow), and their relationship to the surrounding structures. The CR images also provide increased textural information about the surrounding organs.
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In Fig. 8, the serpiginous feeding vessel arising from the celiac trunk is seen in both sagittal and coronal maximum intensity projection views as well as CR views.