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Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications

  • Steven P. RoweEmail author
  • Linda C. Chu
  • Elliot K. Fishman
Special Section: Pancreatitis

Abstract

Inflammation of the pancreas can present with a wide range of imaging findings from mild enlargement of the gland and surrounding infiltrative fat stranding through extensive glandular necrosis. Complications of pancreatitis are varied and include infected fluid collections, pseudocysts, and vascular findings such as pseudoaneurysms and thromboses. Cross-sectional imaging with computed tomography (CT) is one of the mainstays of evaluating patients with pancreatitis. New methods that allow novel visualization volumetric CT data may improve diagnostic yield for the detection of findings that provide prognostic information in pancreatitis patients or can drive new avenues of research such as machine learning. Cinematic rendering (CR) is a photorealistic visualization method for volumetric imaging data that are being investigated for a variety of potential applications including the life-like display of complex anatomy and visual characterization of mass lesions. In this review, we describe the CR appearance of different types of pancreatitis and complications of pancreatitis. We also note possible future directions for research into the utility of CR for pancreatitis.

Keywords

Acute interstitial edematous pancreatitis Necrotizing pancreatitis Pseudocyst Walled-off pancreatic necrosis Thrombosis Pseudoaneurysm 

Notes

Funding

No funding was received by the authors in relation to writing this manuscript.

Compliance with ethical standards

Conflict of interest

EKF receives research support from Siemens and GE Healthcare and is a co-founder and stockholder in HipGraphics, Inc. The other authors have no relevant conflicts of interest to report.

Ethical approval

This manuscript does not detail a defined study and no ethical approval was necessary.

Informed consent

No patient data are included in this manuscript and informed consent was not applicable.

References

  1. 1.
    Zaheer A, Singh VK, Qureshi RO, et al. (2013) The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines. Abdom Imaging. 38(1):125–136.CrossRefGoogle Scholar
  2. 2.
    Mofidi R, Duff MD, Wigmore SJ, et al. (2006) Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. 93(6):738-744.CrossRefGoogle Scholar
  3. 3.
    Ghandili S, Shayesteh S, Fouladi DF, et al. (2019) Emerging imaging techniques for acute pancreatitis. Abdom Radiol (NY). Epub ahead of print.Google Scholar
  4. 4.
    Working Group IAP/APA Acute Pancreatitis Guidelines. (2013) IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 13(4 Suppl 2):e1-e15.Google Scholar
  5. 5.
    Klein Klouwenberg PM, Ong DS, Bonten MJ, Cremer OL. (2012) Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Intensive Care Med. 38(5):811–819.CrossRefGoogle Scholar
  6. 6.
    Dappa E, Higashigaito K, Fornaro J, Leschka S, Wildermuth S, Alkadhi H. (2016) Cinematic rendering – an alternative to volume rendering for 3D computed tomography imaging. Insights Imaging 7(6):849–856.CrossRefGoogle Scholar
  7. 7.
    Eid M, De Cecco CN, Nance JW Jr, et al. (2017) Cinematic rendering in CT: a novel, lifelike 3D visualization technique. AJR Am J Roentgenol 209(2):370–379.CrossRefGoogle Scholar
  8. 8.
    Johnson PT, Schneider R, Lugo-Fagundo C, Johnson MB, Fishman EK. (2017) MDCT angiography with 3D rendering: a novel cinematic rendering algorithm for enhanced anatomic detail. AJR Am J Roentgenol 209(2):309–312.CrossRefGoogle Scholar
  9. 9.
    Soyer P. (2019) Cinematic rendering: when virtuality comes true. Diagn Interv Imaging. 100(9):465–466.CrossRefGoogle Scholar
  10. 10.
    Rowe SP, Fritz J, Fishman EK. (2018) CT evaluation of musculoskeletal trauma: initial experience with cinematic rendering. Emerg Radiol. 25(1):93–101.CrossRefGoogle Scholar
  11. 11.
    Rowe SP, Johnson PT, Fishman EK. (2018) Cinematic rendering of cardiac CT volumetric data: principles and initial observations. J Cardiovasc Comput Tomogr. 12(1):56–59.CrossRefGoogle Scholar
  12. 12.
    Elshafei M, Binder J, Baecker J, et al. (2019) Comparison of cinematic rendering and computed tomography for speed and comprehension of surgical anatomy. JAMA Surg. Epub ahead of print.Google Scholar
  13. 13.
    Rowe SP, Chu LC, Fishman EK. (2018) Cinematic rendering of small bowel pathology: preliminary observations from this novel 3D CT visualization method. Abdom Radiol (NY). 43(11):2928–2937.CrossRefGoogle Scholar
  14. 14.
    Chu LC, Johnson PT, Fishman EK. (2018) Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities. Abdom Radiol (NY). 43(11):3009–3015.CrossRefGoogle Scholar
  15. 15.
    Rowe SP, Chu LC, Fishman EK. (2019) Computed tomography cinematic rendering in the evaluation of colonic pathology: technique and clinical applications. J Comput Assist Tomogr. 43(3):475–484.CrossRefGoogle Scholar
  16. 16.
    Tenner S, Sica G, Hughes M, et al. (1997) Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology. 113(3):899–903.CrossRefGoogle Scholar
  17. 17.
    Lopes Vendrami C, Shin JS, Hammond NA, Kothari K, Mittal PK, Miller FH. (2019) Differentiation of focal autoimmune pancreatitis from pancreatic ductal adenocarcinoma. Abdom Radiol (NY). Epub ahead of print.Google Scholar
  18. 18.
    Madhani K, Farrell JJ. (2016) Autoimmune pancreatitis: an update on diagnosis and management. Gastroenterol Clin North Am. 45(1):29–43.CrossRefGoogle Scholar
  19. 19.
    Rowe SP, Chu LC, Fishman EK. (2019) 3D CT cinematic rendering of the spleen: potential role in problem solving. Diagn Interv Imaging. 199(9):477–483.CrossRefGoogle Scholar
  20. 20.
    Chen Y, Chen TW, Wu CQ, et al. (2019) Radiomics model of contrast-enhanced computed tomography for predicting the recurrence of acute pancreatitis. Eur Radiol. 29(8):4408–4417.CrossRefGoogle Scholar
  21. 21.
    Mahmood F, Chen R, Sudarsky S, Yu D, Durr NJ. (2018) Deep learning with cinematic rendering: fine-tuning deep neural networks using photorealistic medical images. Phys Med Biol. 63(18):185012.CrossRefGoogle Scholar
  22. 22.
    Hughey M, Taffel M, Zeman RK, Patel S, Hill MC. (2017) The diagnostic challenge of the sequelae of acute pancreatitis on CT imaging: a pictorial essay. Abdom Radiol (NY). 42(4):1199–1209.CrossRefGoogle Scholar
  23. 23.
    Siegelman SS, Copeland BE, Saba GP, Camerson JL, Sanders RC, Zerhouni EA. (1980) CT of fluid collections associated with pancreatitis. AJR Am J Roentgenol. 134(6):1121–1132.CrossRefGoogle Scholar
  24. 24.
    Manrai M, Kochlar R, Gupta V, et al. (2018) Outcome of acute pancreatic and peripancreatic collections occurring patients with acute pancreatitis. Ann Surg. 267(2):357–363.CrossRefGoogle Scholar
  25. 25.
    Johnson PT, Heath DG, Kuszyk BS, Fishman EK. (1996) CT angiography with volume rendering: advantages and applications in splanchnic vascular imaging. Radiology. 200(2):564–568.CrossRefGoogle Scholar
  26. 26.
    Easler J, Muddana V, Furlan A, et al. (2014) Portosplenomesenteric venous thrombosis in patients with acute pancreatitis is associated with pancreatic necrosis and usually has a benign course. Clin Castroenterol Hepatol. 12(5):854–862.CrossRefGoogle Scholar
  27. 27.
    Tessier DJ, Stone WM, Fowl RJ, et al. (2003) Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg. 38(5):969–974.CrossRefGoogle Scholar
  28. 28.
    Rowe SP, Johnson PT, Fishman EK. (2018) Initial experience with cinematic rendering for chest cardiovascular imaging. Br J Radiol. 91(1082):20170558.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Rowe SP, Johnson PT, Fishman EK. (2018) MDCT of ductus diverticulum: 3D cinematic rendering to enhance understanding of anatomic configuration and avoid misinterpretation as traumatic aortic injury. Emerg Radiol. 25(2):209–213.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Steven P. Rowe
    • 1
    Email author
  • Linda C. Chu
    • 1
  • Elliot K. Fishman
    • 1
  1. 1.The Russell H. Morgan, Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA

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