Abdominal Radiology

, Volume 43, Issue 11, pp 2928–2937 | Cite as

Cinematic rendering of small bowel pathology: preliminary observations from this novel 3D CT visualization method

  • Steven P. RoweEmail author
  • Linda C. Chu
  • Elliot K. Fishman
Pictorial essay


3D visualization methods for volumetric CT data have played an important role in diagnostic imaging of the small bowel, a structure which intrinsically crosses numerous slices in any 2D imaging plane. Recently, a new approach to 3D CT image creation has become available—cinematic rendering (CR). CR differs from other 3D methods in making use of a global lighting model that produces high surface detail and realistic shadowing effects that lead to 3D visualizations with photorealistic quality. Although the utility of these images for improving diagnostic accuracy has not yet been established, our group’s early experience in regions of complex anatomy and pathology has been encouraging. In this pictorial review, we review the established role of 3D CT in many of the most common small bowel pathologies, provide examples of those pathologies visualized with CR, and suggest future directions for researchers to pursue.


Cinematic rendering 3D CT Carcinoid Gastrointestinal stromal tumor 


Compliance with ethical standards


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

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.


  1. 1.
    Fishman EK, Bluemke DA, Soyer P (2016) Three-dimensional imaging: past, present and future. Diagn Interv Imaging 97(3):283–285CrossRefGoogle Scholar
  2. 2.
    Horton KM, Fishman EK (2003) The current status of multidetector row CT and three-dimensional imaging of the small bowel. Radiol Clin North Am 41(2):199–212CrossRefGoogle Scholar
  3. 3.
    Horton KM, Fishman EK (2004) Multidetector-row computed tomography and 3-dimensional computed tomography imaging of small bowel neoplasms: current concept in diagnosis. J Comput Assist Tomogr 28(1):106–116CrossRefGoogle Scholar
  4. 4.
    Johnson PT, Horton KM, Fishman EK (2009) Nonvascular mesenteric disease: utility of multidetector CT with 3D volume rendering. Radiographics 29(3):721–740CrossRefGoogle Scholar
  5. 5.
    Dappa E, Higashigaito K, Fornaro J, et al. (2016) Cinematic rendering—an alternative to volume rendering for 3D computed tomography imaging. Insights Imaging 7(6):849–856CrossRefGoogle Scholar
  6. 6.
    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):370–379CrossRefGoogle Scholar
  7. 7.
    Johnson PT, Schneider R, Lugo-Fagundo C, et al. (2017) MDCT angiography with 3D rendering: a novel cinematic rendering algorithm for enhanced anatomic detail. AJR Am J Roentgenol 209(2):309–312CrossRefGoogle Scholar
  8. 8.
    Rowe SP, Fritz J, Fishman EK (2018) CT evaluation of musculoskeletal trauma: initial experience with cinematic rendering. Emerg Radiol 25(1):93–101CrossRefGoogle Scholar
  9. 9.
    Rowe SP, Johnson PT, Fishman EK (2018) Initial experience with cinematic rendering for chest cardiovascular imaging. Br J Radiol 91(1082):20170558PubMedGoogle Scholar
  10. 10.
    Rowe SP, Johnson PT, Fishman EK (2018) Cinematic rendering of cardiac CT volumetric data: principles and initial observations. J Cardiovasc Comput Tomogr 12(1):56–59CrossRefGoogle Scholar
  11. 11.
    Rowe SP, Zinreich J, Fishman EK (2018) 3D cinematic rendering of the calvarium, maxillofacial structures, and skull base: preliminary observations. Br J Radiol 24:20170826. CrossRefGoogle Scholar
  12. 12.
    Caoili EM, Paulson EK (2000) CT of small-bowel obstruction: another perspective using multiplanar reformations. AJR Am J Roentgenol 174(4):993–998CrossRefGoogle Scholar
  13. 13.
    Boudiaf M, Soyer P, Terem C, et al. (2001) CT evaluation of small bowel obstruction. Radiographics 21(3):613–624CrossRefGoogle Scholar
  14. 14.
    Hong SS, Kim AY, Kwon SB, et al. (2010) Three-dimensional CT enterography using oral gastrografin in patients with small bowel obstruction: comparison with axial CT images or fluoroscopic images. Abdom Imaging 35(5):556–562CrossRefGoogle Scholar
  15. 15.
    Feng ST, Chan T, Sun CH, et al. (2010) Multiphasic MDCT in small bowel volvulus. Eur J Radiol 76(2):e13–e18CrossRefGoogle Scholar
  16. 16.
    Garcelan-Trigo JA, Tello-Moreno M, Rabaza-Espigares MJ, Talavera-Martinez I (2015) Barber pole sign in CT angiography, adult presentation of midgut malrotation: a case report. Iran J Radiol 12(3):e17853CrossRefGoogle Scholar
  17. 17.
    Childers BC, Cater SW, Horton KM, Fishman EK, Johnson PT (2015) CT evaluation of acute enteritis and colitis: is it infectious, inflammatory, or ischemic?: resident and fellow education feature. Radiographics 35(7):1940–1941CrossRefGoogle Scholar
  18. 18.
    Liu BY, Liang CH, Zhang ZL, et al. (2006) Crohn disease of small bowel: multidetector row CT with CT enteroclysis, dynamic contrast enhancement, CT angiography, and 3D imaging. Abdom Imaging 31(6):668–674CrossRefGoogle Scholar
  19. 19.
    Horton KM, Lawler LP, Fishman EK (2003) CT findings in sclerosing mesenteritis (panniculitis): spectrum of disease. Radiographics 23(6):1561–1567CrossRefGoogle Scholar
  20. 20.
    Kim JS, Park SH, Hansel S, Fletcher JG (2017) Imaging and screening of cancer of the small bowel. Radiol Clin North Am 55(6):1273–1291CrossRefGoogle Scholar
  21. 21.
    Horton KM, Juluru K, Montogomery E, Fishman EK (2004) Computed tomography imaging of gastrointestinal stromal tumors with pathology correlation. J Comput Assist Tomogr 28(6):811–817CrossRefGoogle Scholar
  22. 22.
    Sheth S, Horton KM, Garland MR, Fishman EK (2003) Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. Radiographics 23(2):457–473CrossRefGoogle Scholar
  23. 23.
    Suthiwartnarueput W, Kiatipunsodsai S, Kwankua A, Chaumrattanakul U (2012) Lymphangioma of the small bowel mesentery: a case report and review of the literature. World J Gastroenterol 18(43):6328–6332CrossRefGoogle Scholar
  24. 24.
    Lee KS, Hwang S, Hurtado Rúa SM, Janjigian YY, Gollub MJ (2013) Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features. AJR Am J Roentgenol 200(5):1042–1047CrossRefGoogle Scholar
  25. 25.
    Pear BL (1998) Pneumatosis intestinalis: a review. Radiology 207(1):13–19CrossRefGoogle Scholar
  26. 26.
    Horton KM, Jeffrey RB Jr, Federle MP, Fishman EK (2009) Acute gastrointestinal bleeding: the potential role of 64 MDCT and 3D imaging in the diagnosis. Emerg Radiol 16(5):349–356CrossRefGoogle Scholar
  27. 27.
    Raman SP, Horton KM, Fishman EK (2013) MDCT and CT angiography evaluation of rectal bleeding: the role of volume visualization. AJR Am J Roentgenol 201(3):589–597CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

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 Science, The James Buchanan Brady Urological Institute and Department of UrologyJohns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations