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Aktuelle Bildnachverarbeitung der aortalen CTA und MRA

Image postprocessing of aortic CTA and MRA

  • Leitthema: Aorta
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Zusammenfassung

Die multiplanare Reformatierung (MPR) der Bilddaten aortaler CTA und MRA ist die wichtigste Rekonstruktionsmethode im Hinblick auf eine differenzierte Therapieentscheidung und die präoperative Therapieplanung sowie die Beschreibung postoperativer Komplikationen. Die gekrümmte MPR wird semiautomatisch bzw. vollständig automatisch als Centerline im Gefäßlumen berechnet und für die Bestimmung des orthogonalen Durchmessers und der Längsausdehnung der Pathologie verwendet. Eine reproduzierbar exakte Ausmessung komplexer Pathologien und Gefäßlängsverläufe erweitert das Spektrum der diagnostischen Radiologie. Die gekrümmte MPR dient der semiautomatischen Berechnung der Gefäßmittellinie. Die heutigen Gerätekonsolen können bereits automatisch Maximum-Intensitätsprojektionen (MIP) und Standard-MPR anfertigen und ins Archiv versenden. Die 3D-Visualisierung kann als Volume-rendering-Technik (VRT) effektiv bei der Patientenselektion, Therapieplanung und Nachsorge behilflich sein und in der interdisziplinären Kommunikation des klinischen Alltags ergänzend zu den Quelldaten eingesetzt werden. Die Segmentierung von Hochkontraststrukturen ist meist semiautomatisch möglich, Weichteilstrukturen müssen jedoch weiterhin manuell segmentiert werden. Zur Bildnachverarbeitung sind isotrope CTA-Daten meist besser geeignet als MR-Datensätze, die häufig noch anisotrop sind. In vielen europäischen Ländern wird die Bildnachverarbeitung noch nicht adäquat vergütet, obwohl die Überweiser die 3D-Visualisierungen und Vermessungen oftmals mit Nachdruck einfordern.

Abstract

Multiplanar reformation (MPR) is the most relevant tool for patient selection and precise procedural planning and also for analyzing postinterventional complications. Curved MPR is used primarily for semiautomated or completely automated calculation of the centerline of the vascular lumen and to estimate the orthogonal vessel diameter and longitudinal extent. Reproducible and accurate measurement of complex pathologies and courses of vessels extends the range of diagnostic radiology. Contemporary scanner consoles allow automated processing of maximum intensity projections (MIP) and standard MPR and their storage in PACS. To improve patient selection, procedural planning, root-cause analysis postoperatively for assessment of treatment effects and to make better communication of findings to nonradiologists possible, volume rendering techniques (VRT) are a beneficial adjunct to source images. With current algorithms semiautomated segmentation is satisfactory for vessels and bones, but not for low-contrast structures (soft tissues), which still need to be segmented manually. In general, isotropic CT source data are preferable to MR images, which are often anisotropic. In many European countries image postprocessing is still not adequately reimbursed although the doctors making referrals often specifically and emphatically demand 3D visualization and measurements in daily practice.

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Authors and Affiliations

  1. Abteilung Radiologie E010, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland

    H. von Tengg-Kobligk, T.F. Weber, F. Rengier & H.-U. Kauczor

  2. Klinik für Gefäßchirurgie, vaskuläre und endovaskuläre Chrirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland

    D. Böckler

  3. Klinik für Gefäßchirurgie, Klinikum der Stadt Hanau, Hanau, Deutschland

    H. Schumacher

Authors
  1. H. von Tengg-Kobligk
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  2. T.F. Weber
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  3. F. Rengier
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  4. D. Böckler
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  5. H. Schumacher
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  6. H.-U. Kauczor
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Corresponding author

Correspondence to H. von Tengg-Kobligk.

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Dieser Artikel ist Prof. Dr. med. Jens-Rainer Allenberg gewidmet.

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von Tengg-Kobligk, H., Weber, T., Rengier, F. et al. Aktuelle Bildnachverarbeitung der aortalen CTA und MRA. Radiologe 47, 1003–1011 (2007). https://doi.org/10.1007/s00117-007-1583-8

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  • DOI: https://doi.org/10.1007/s00117-007-1583-8

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