Clinical Applications

syngo Vessel View Semi-automated Protocol-Driven Analysis Tool for CT- and MR-Angiography Data

syngo Vessel View Semi-automated Protocol-Driven Analysis Tool for CT- and MR-Angiography Data

Features and Benefits Stenosis quantification and aneurysm assessment Clinical protocols for workflow support and reliable results Semi-automatic visualization of vessels from CT and MR angiography data sets Image Display Integrated MPR and volume rendering views Color presets shared with syngo 3D application Large screen segment for data set interaction Blow-up mode for improved visualization Generation and display of vessel axial MPRs along vessel centerlines Automated Segmentation Tools Semi-automatic visualization of vessel lumens Automatic visualization and measurement of vessel cross-sections in MPR views Quantitative Analysis Diameter and cross-sectional area measurement Comparative measurement of vessel size in different location (normal, stenotic) Curved measurements

Digital Reports Saving of MPR and volume rendering reference images Results tables saved as DICOM images for hardcopy or softcopy reporting Landmark based reporting for easy reference between anatomy and measurements Integrated Vessel Navigator Longitudinal MPR with vessel area curve for navigation along vessel path and measurement of vessel diameter AVI creation of multiple orientation vessel cross-sections Protocols Multiple protocols available for stenosis measurement or aneurysm analysis with peripheral as well as coronary vessels, and other clinical applications Rapid documentation protocols for standard view creation Pre-requisite syngo 3D Basic For hardware requirements please refer to the individual system datasheets

Segmentation of the Carotid Artery (CT data)

Centerline calculation and area measurement (MR data)

Evaluation with Vessel Navigator (MR data)

Curved distance measurement (CT data)

Case Study 1 Multislice CT and syngo Vessel View Evaluation of Stenosis of the Right Common Iliac Artery
syngo Vessel View is a dedicated tool for 3D visualization and analysis of vascular structures in CT and also MR.

History
A 50-year-old female patient was referred for a CT scan, after a Doppler ultrasound exam demonstrated stenosis of both the internal and external iliac arteries on the right side. The CT scan confirmed the ultrasound image findings and revealed that there was extensive blockage at the level just above the right common iliac artery bifurcation.

Examination Protocol
Scanner kV Effective mAs Collimation Slice width Table feed/rotation Kernel Post processing SOMATOM Volume Access 120 kV 73 mAs 1 mm 1.25 mm 3.5 mm B20f Data was processed with syngo Vessel View function on the Wizard

[1] The evaluation starts with a VRT, for which a pre-set from the image gallery can be chosen

[2] After visualizing and delineating the vessel it will be subtracted and can be shown with a faded (transparent) VRT in the background

[4] (A + B + C) VRT of the pelvis showing the vessels

Diagnosis and Comments

In this case, syngo Vessel View facilitated comparative measurement of the diameter and cross-sectional area of the right common iliac vessel at the site of the blockage and the area on either side. This noninvasive pre-surgical evaluation of the vessels and landmark based reporting, using CT and syngo Vessel View, enabled surgeons to make a more accurate treatment plan prior to intervention. Evaluation began with a VRT, for which a pre-set from the image gallery was chosen [1]. Having visualized and delineated the vessel it was subtracted and is shown with a transparent VRT in the background [2]. The syngo Vessel View Vessel Navigator function enabled evaluation at the level before and after the blockage of both parts of the right common Iliac artery [3], Vessel Navigator allowed measurement of vessel diameter before and after the blockage. A VRT of the pelvis was also constructed [4], giving an overview of the vasculature.

Courtesy of Radiology Mnchen Nord, Germany

[3] (A + B) In the Vessel Navigator both parts of the right common iliac artery can be evaluated
A B

Case Study 2 Multislice CT and syngo Vessel View Follow-up Study of a Right Coronary Artery Stent
syngo Vessel View is a dedicated tool for 3D visualization and analysis of vascular structures in CT and also MR.

History
A 40-year-old male patient was brought into the emergency room, having suffered a heart attack while at work. There was no familial history of heart attack, but the patient was a heavy smoker. The patient was immediately sent to the coronary catheter lab, where he underwent stenting of the right coronary artery. Five days after the event he was referred for a CTA of the coronary vessels, primarily to evaluate the stent.

[1] Right coronary artery with a faded VRT of the heart in the background. You can clearly see the stent in the selected vessel

[2] The Vessel Navigator shows a longitudinal cut along the RCA, the so-called Ribbon-MPR. The implemented stent can be evaluated (in this case: diameter, length)

[3] Maximum Intensity Projection of the stent in the RCA

Examination Protocol
Scanner Scan direction kV Effective mAs Collimation Slice width Table feed/rotation Kernel Contrast Volume Flow rate Start delay SOMATOM Sensation 16 Cranio-caudal 120 kV 500 mAs 0.75 mm 1 mm 2.8 mm B20f Non-ionic contrast media 90 cc 3.5 cc/s Delay tailored using a test bolus of 20 cc contrast at 4 cc/s Data was processed using syngo Vessel View on the Wizard console

Diagnosis and Comments

Initial views of the right coronary artery with a faded VRT of the heart, enabled clear identification of the stent in the selected vessel [1]. Using the RibbonMPR functionality that is unique to syngo Vessel View, a longitudinal cut along the RCA facilitated evaluation of the diameter and length of the stent, and additionaly demonstrated stent patency [2]. An MIP view is also shown [3]. Finally unique volume rendering techniques provided excellent views of the stent in situ [4], facilitating more accurate and informative reporting. The option syngo Vessel View is a dedicated tool for 3D visualization and analysis of vascular structures. In addition to vessel analysis, this option is also very useful for pre-surgical evaluation, which requires direct measurements in a 3D-volume data set. In this special case it was possible to have a closer look into the lumen of the stent to determine whether the stent was open or not. The measurements that can be done are very useful for surgeons and cardiologists for any later surgery that might be necessary.

Post processing

[4] Volume Rendering Technique visualizes the course of the coronary vessel and the location of the stent (white) in a very good optical view

Courtesy of Klinikum Grosshadern, Munich, Germany

The drugs and doses mentioned herein are consistent with the approval labeling for uses and/or indications of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in connection with such use. The Operating Instructions must always be strictly followed when operating the MR/CT System. The source for the technical data are the corresponding data sheets. The information in this document contains general descriptions of the technical options available, which do not always have to be present in individual cases. The required features should therefore be specified in each individual case at the time of closing the contract. Siemens reserves the right to modify the design and specifications contained herein without prior notice. Please contact your local Siemens Sales representative for the most current information. Original images always lose a certain amount of detail when reproduced.

Siemens Medical Solutions that help

Siemens AG, Medical Solutions Computed Tomography Siemensstr. 1, D-91301 Forchheim Germany Telephone: ++49 9191 18-0

Siemens AG, Medical Solutions Henkestr. 127, D-91052 Erlangen Germany Telephone: ++49 9131 84-0 www.SiemensMedical.com

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