CT virtual endoscopy in the visualization of cardiovascular disease: A pictorial essay

Abstract

Learning Objectives: To understand the spectrum of imaging findings of CT virtual endoscopy in a number of cardiovascular diseases including carotid artery disease (pre-and post-carotid stenting), coronary artery disease (pre-and post-coronary stenting), pulmonary embolism, abdominal aortic aneurysm (pre-and post-stent graft repair); to assist readers to be familiar with the intraluminal appearances when compared with conventional 2D/3D external views; to identify the potential applications of virtual endoscopy in each particular abnormality.Background: Currently, less invasive imaging modalities, particularly multislice CT angiography has been widely used as an effective alternative to invasive angiography in both pre-operative planning and post-operative follow-up of the cardiovascular diseases due to its increased spatial and temporal resolution. In addition to traditional 2D axial images, a series of 3D reconstructions are routinely generated to provide additional information for clinicians to accurately assess the disease extent, as well as evaluation of the treatment outcomes. Of these reconstructions, virtual endoscopy is an emerging tool which shows promising role in some areas. We presented our experience of using virtual endoscopy in the visualization of a number of cardiovascular diseases.Imaging Findings: Intravascular appearances of normal arteries and the branches including carotid, coronary, pulmonary arteries and abdominal aorta and the corresponding pathological changes such as stenosis, plaques, thrombus or aneurysms were demonstrated with CT virtual endoscopy. In addition, intraluminal visualization of the carotid and coronary stent and endovascular stent grafts was also performed with virtual endoscopy. Virtual endoscopy images were compared with conventional 2D views with regard to the additional information it offers or potential applications it demonstrates for evaluation of the above cardiovascular diseases.Conclusion: Recognition of the diagnostic value of virtual endoscopy in these cardiovascular diseases is valuable for assisting clinicians to effectively utilize CT angiography for both diagnosis and follow-up of treatment outcomes.